La. Admin. Code tit. 50 § II-10139

Current through Register Vol. 50, No. 11, November 20, 2024

Section II-10139 - Hospice Services

A. Effective July 1, 1993, a Louisiana nursing facility (NF) resident who is eligible for both Medicare and Medicaid can elect the Medicare hospice benefit if the nursing facility is being or will be reimbursed for the resident's care by Medicaid.

B. Hospice care focuses on assuring the quality of the terminal resident's remaining life rather than on trying to prolong the length of that life. It is a program of palliative (control of pain and symptoms) and supportive services which provides physical, psychological, social and spiritual care for dying persons and families.

C. Hospice Admission Criteria

1. Resident is enrolled in Medicare Part A and is Medicaid eligible or in applicant status.

2. A prognosis of six months or less confirmed by the attending physician. The prognosis of the terminal illness must be in terms of days, weeks, or months.

3. Election of the hospice benefit must be made by the competent resident or family member in the order described by Louisiana law for the non-competent resident.

4. Care goal must be palliative and not curative.

5. Resident shall be under the care of an attending physician who consents to the Hospice admission and who will continue to assume responsibility for medical care.

6. The resident lives in a nursing facility within the Hospice service area.

7. Final determination of medical eligibility for admission to hospice is made by the Health Standards Section of the Bureau of Health Services Financing.

D. Provider Responsibilities. The nursing facility and the hospice shall have a contractual agreement outlining the specific responsibilities of each entity which shall include but is not limited to:

1. eligible residents;

2. services to be furnished by the Hospice;

3. services to be furnished by the nursing facility;

4. cooperation in professional management;

5. financial responsibility;

6. provider of first choice;

7. public relations;

8. compliance with government regulations;

9. terms of agreement; and

10. indemnification and limit of liability.

E. This agreement shall commence as of the date appearing and continue until terminated by either party by giving 30 days written notice to the other party. This agreement may be amended by mutual agreement of the NF and Hospice.

F. The NF and Hospice shall continue to meet all federal regulations for certification and state requirements for licensure.

G. The resident who is receiving Hospice in the NF will be subject to surveys for both the Long Term Care and Hospice programs.

H. Medicaid Reimbursement. When a dually eligible resident elects the Medicare hospice benefit and the hospice and the nursing facility have a written agreement under which the hospice is responsible for the professional management of the resident's hospice care and the NF agrees to provide room and board to the resident, the Medical Assistance Program will pay the hospice an amount equal to the per diem for NF care. Medicaid payment to the NF is discontinued when payment to the hospice begins. Discharge and admission forms (Form 148) are filed by the NF and the hospice provider effecting the transfer.

1. With respect to the management of a resident's terminal illness, the NF shall:

a. notify Hospice of changes in the resident's condition; and

b. make records of care and services to the resident available to Hospice.

2. The NF may continue to collect the resident's personal liability income (PLI) to be applied to the Medicaid per diem.

I. Admission Review. The following procedures shall be followed when the Hospice benefit is elected by the dually eligible resident currently residing in the NF:

1. The NF shall:

a. discontinue billing Medicaid on the date the hospice is elected and an agreement between NF and Hospice is signed and effectuated;

b. notify the Health Standards Regional Office and respective parish office by Form 148 that the resident is being placed in the Hospice category on effective date; and

c. provide the hospice provider a copy of Form 148 indicating the date of transfer to Hospice.

2. The Hospice is responsible for submitting the following information to the Health Standards Regional Office for review:

a. the attending physician's referral confirming prognosis of less than six months and to approve the hospice admission;

b. the hospice RN assessment;

c. the plan of care;

d. Form 148 to indicate the effective date of admission to hospice care, and a copy of Form 148 from the NF indicating the date of transfer for those residents who are already placed in a NF.

3. The following procedures shall be followed when the Hospice benefit is elected by an individual prior to admission to the NF:

a. The NF shall submit Form 148, 90-L, and PASARR-1 to the Health Standards Regional Office for review.

NOTE: Form 148 will specify the level of care, effective date of admission and add the notation at the bottom of the admission section that the resident is entering the hospice at the same time. Representatives of both the NF and the Hospice should sign Form 148 at the bottom.

b. The Hospice shall submit the following information to the Health Standards Regional Office for review:

i. the attending physician's referral confirming prognosis of less than six months and to approve the hospice admission;

ii. the hospice RN assessment

iii. the plan of care.

J. Provider of First Choice. The NF retains the right to decide if it wishes to offer the option of Hospice. If Hospice is offered, the NF agrees to exert its best efforts to promote the use of Hospice home care services by directing the personnel of the NF to refer all terminally ill residents, subject to the informed consent of the resident and the approval of the attending physician, to the Hospice. If the NF chooses not to offer Hospice and a resident wishes to receive the services, the resident shall be informed that Hospice is not available in the NF and assist with arrangements for transfer to another facility that offers the service if they so choose.

La. Admin. Code tit. 50, § II-10139

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 22:34 (January 1996).

AUTHORITY NOTE: Promulgated in accordance with R.S. 46:153