Provider Notice issued 07/30/14

New Hospice Requirements Regarding the HFS 1592 and Physician Certification of Terminal Illness Statement

This notice identifies to hospice agencies new submission requirements for Form HFS 1592 - Notification to HFS of Hospice Benefit Election (pdf) and the physician certification of terminal illness statement.

As per current hospice policy, hospice benefit periods consist of two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods. The benefit periods may be used consecutively or at intervals. Regardless of whether they are used consecutively or at intervals, the patient must be certified as terminally ill at the beginning of each benefit period.

New Submission Requirements for Form HFS 1592

Previously, the participant information on the HFS 1592 was entered in the department’s system with only a beginning date, and did not expire until discharge information was submitted by the hospice. Effective July 1, 2014, incoming HFS 1592 participant election information will be entered with an ending date that is 180 days from the initial election date. The 180-day period encompasses the initial two 90-day benefit periods.

Hospice providers will be required to submit an additional HFS 1592 for each 60-day extension period of election. These extensions should be submitted no earlier than 30 days prior to the ending date of the current period, in order to prevent the election from expiring. If the hospice election expires, hospice payments will end and any nursing home room and board payments from the department will be made directly to the nursing home, not to the hospice provider. It is extremely important that the hospice agency notifies the department of election information in a timely manner so as not to disrupt payment to the hospice or its associated nursing homes.

Hospice election information received by the department prior to July 1, 2014 will be reviewed. Any previous election will be given an end date 90 days from July 1, 2014 (September 28, 2014). It is the provider’s responsibility to verify a patient’s hospice eligibility through the department’s Medical Electronic Data Interchange (MEDI). To extend the hospice period for an additional 60 days, the provider must submit a new HFS 1592 and physician certification statement.

Submission of Physician’s Certification Statement

The State Medicaid Manual, Chapter 4, issued by the federal Centers for Medicare and Medicaid Services, specifies that hospices must obtain, no later than two calendar days after hospice care is initiated, written certification statements signed by the medical director of the hospice or the physician member of the hospice interdisciplinary group and the individual’s attending physician (if the individual has an attending physician).

If the hospice does not obtain a written certification within two days after the initiation of hospice care, a verbal certification may be obtained within these two days, and a written certification obtained no later than eight days after care is initiated. If these requirements are not met, no payment can be made for days prior to the certification. The department will adjust the election period dates accordingly.

For any subsequent period, the hospice must obtain, no later than two calendar days after the beginning of that period, a written certification statement prepared by the medical director of the hospice or the physician member of the hospice’s interdisciplinary group. The certification must include the statement that the individual’s medical prognosis is that his or her life expectancy is six months or less if the terminal illness runs its normal course and the signature(s) of the physician(s). The hospice must retain the certification statements.

Effective August 15, 2014, hospices will be required to submit the Physician Certification Statement with the HFS 1592 for the initial 180 day period and each additional 60-day extension. Election information received after August 15, 2014 will not be processed unless the Physician Certification Statement is attached.

Patients Covered under a Managed Care Organization (MCO) or Managed Care Community Network (MCCN)

If a patient is covered under an MCO or MCCN contracted with HFS, the hospice provider must also submit the same HFS 1592 election forms and physician certification statements to the MCO or MCCN.

Any questions regarding this notice should be directed to the hospice’s billing consultant in the Bureau of Hospital and Provider Services 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs