Ala. Admin. Code r. 560-X-51-.05

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-51-.05 - Election Procedures

(1) If an individual meets the eligibility requirements for hospice care, he or she must file a written election certification statement (Medicaid Hospice Election and Physician's Certification, Form 165) with a particular hospice within two calendar days after hospice care begins. An election may also be filed by a representative as defined in Rule 560-X-51-.02(9).

(2) An election to receive hospice care will be considered to continue through the initial election period and through one subsequent election period without a break in care as long as the individual:

(a) Remains in the care of a hospice.

(b) Does not revoke the election provisions under Rule 560-X-51-.07.

(c) Remains eligible for full Medicaid benefits in Alabama.

(3) An individual or representative may designate an effective date that begins with the first day of hospice care or any subsequent day of hospice care. The two 90-day election periods must be used before the 60-day subsequent benefit periods. If an individual revokes the hospice election, any days remaining in that election period are forfeited.

(4) An individual or representative may not designate an effective date that is earlier than the date that hospice care begins.

(5) A Medicaid beneficiary who resides in a nursing home may elect hospice services. The hospice must have a contract with the nursing home to delineate which services each has responsibility to provide. A contract is necessary to clarify the details of how the nursing home and hospice will work together.

(6) If an individual is eligible for Medicare as well as Medicaid, the Medicare election form will serve as election for both hospice programs. If an individual eligible for Medicare and Medicaid enters the nursing home, is discharged from the nursing home to the hospital, is readmitted to the nursing home following hospitalization, is discharged from the nursing home to the community, or expires; the hospice provider must complete and return the Change in Status of Hospice Recipient, Form 165B, to the Medicaid Agency or its designee.

Ala. Admin. Code r. 560-X-51-.05

Emergency Rule effective October 1, 1990. Permanent Rule effective February 13, 1991. Emergency Rule effective May 15, 1991. Amended: effective August 14, 1991. Amended: Filed August 6, 1993; effective September 10, 1993. Amended: Filed May 10, 2002; effective June 14, 2002. Amended: Filed May 12, 2005; effective June 16, 2005. Amended: Filed April 11, 2006; effective May 16, 2006. Amended: Filed August 11, 2008; effective September 15, 2008. Amended: Filed August 9, 2012; effective September 13, 2012.

Author: Felicha Fisher, Administrator, LTC Policy/Recipient Services Unit, Long Term Care Division

Statutory Authority: Title XIX, Social Security Act; 42 C.F.R. § 418.24; State Plan..