(a) If the hospice believes that the period of crisis
will extend beyond five consecutive days, the IDT must discuss the
temporary alternate placement available to meet the needs of the individual
during the period of crisis, such as a hospital or nursing facility.
This discussion must occur and be documented before the fifth day
of the crisis. If, after this discussion, the hospice believes that
an extension of CHC is necessary instead of alternate placement, the
hospice must fax a Request for CHC Extension Form to HHSC.
(1) The extension request must be faxed to HHSC by
the fourth day of the CHC period.
(2) The extension request must include:
(A) a description of the specific crisis and how the
hospice plans to resolve the crisis;
(B) documentation of all CHC provided during the period
of crisis for which the hospice is seeking the extension;
(C) physician's orders;
(D) documentation of daily physician plan of care oversight;
(E) documentation that skilled nursing care was provided
as more than half of the care given in a 24-hour period for each of
the three days of CHC;
(F) documentation of the IDT's discussion regarding
alternate placement prior to the initiation of CHC; and
(G) documentation of the reasons the CHC period must
be extended, including the reasons the originally documented alternate
placement is no longer appropriate or desired.
(b) HHSC denies the CHC extension request if the documentation
is incomplete.
(c) HHSC reviews documentation faxed on or before the
fourth consecutive day of the period of crisis within 16 work hours
of receiving the documentation if it is sent in accordance with the
instructions in subsection (a)(1) of this section.
(d) HHSC will not consider requests faxed after the
fourth consecutive day of the period of crisis.
(e) HHSC will not consider multiple requests for extensions
for the same period of crisis.
(f) HHSC notifies a hospice in writing, via fax, of
its decision no later than the end of the fifth consecutive day of
the period of crisis.
(g) If HHSC denies the request for an extension of
CHC, HHSC sends a notice of denial to the individual whose CHC the
hospice was seeking to extend. The notice of denial informs the individual
of the individual's right to request a Medicaid fair hearing in accordance
with 1 TAC Chapter 357, Subchapter A (relating to Uniform Fair Hearing
Rules).
(h) If HHSC denies the request for an extension of
CHC, HHSC pays the hospice at the routine home care rate or inpatient
care rate, if applicable, for subsequent days of care.
(i) The approval of a CHC extension request is not
an approval of the initial CHC period, nor an approval for the care
provided during the extension period. HHSC will conduct a review of
all paid CHC claims to determine compliance with eligibility requirements
for the hospice payment.
|