R414-14A-6. Hospice Election

  (1) A client who meets the eligibility requirement for Medicaid hospice must file an election statement with a particular hospice. If the client cannot cognitively make informed health care decisions or is under 18 years of age, the client's legally authorized representative may file the election statement.

  (2) Each hospice provider designs and prints his own election statement. The election statement must include the following:

  (a) identification of the particular hospice that will provide care to the client;

  (b) the client's or representative's acknowledgment that he or she has been given a full understanding of the palliative rather than curative nature of hospice care, as it relates to the client's terminal illness;

  (c) for adult clients, acknowledgment that the client waives certain Medicaid services as set forth in Section R414-14A-9;

  (d) acknowledgment that the client or representative may revoke the election of the hospice benefit at any time in the future and therefore become eligible for Medicaid services waived at the time of hospice election as set forth in Section R414-14A-8; and

  (e) the signature of the client or representative.

  (3) The effective date of the election may be the first day of hospice care or a later date, but may be no earlier than the date of the election statement

  (4) An election to receive hospice care remains effective through the initial election period and through the subsequent election periods without a break in care as long as the client:

  (a) remains in the care of a hospice;

  (b) does not revoke the election; and

  (c) is not discharged from the hospice.

  (5) The hospice provider must notify the Department at the time a Medicaid client selects the hospice benefit, including selecting the hospice provider under a change of designated hospice. The notification must include a copy of the hospice election statement and the physician's certification of terminal illness for hospice care. Authorization for reimbursement of hospice care begins no earlier than the date notification is received by the Department for an eligible Medicaid client, except as provided in Section R414-14A-20.

  (6) Subject to the conditions set forth in this rule, a client may elect to receive hospice care during one or more of the following election periods:

  (a) an initial 90-day period;

  (b) a subsequent 90-day period; or

  (c) an unlimited number of subsequent 60-day periods.

  (7) The Department may only grant prior authorization for hospice care in alignment with the election periods defined in Subsection R414-14A-6(6).