• General Information
  • Introduction
  • Core and Other Functions of Hospice
    • Introduction
    • Core Functions
    • Other Functions
  • Provider Certification
  • Scope of Service
  • Medicaid Provider Responsibilities
  • Hospice Responsibilities
  • Recipient Eligibility
  • Hospice Enrollment
  • Hospice Recipient Requirements
    • Designated Primary Provider
    • Discontinuation or Transfer
    • Recipients Residing in Nursing Homes
  • Copayment
• Covered Services
  • Hospice Care Service Categories
  • Hospice Care Services and Limitations
    • Introduction
    • Routine Care
    • Continuous Care
    • Inpatient Respite Care
    • General Inpatient Care
  • Nursing Home Room and Board
    • Introduction
    • Limitations Applicable to Nursing Home Room and Board
  • Physician Services
  • Durable Medical Equipment/Personal Care Services
  • Reimbursement Not Available
• Required Documentation
  • Introduction
  • Physician Certification/ Recertification of Terminal Illness
  • Recipient Election of Medicaid Hospice Benefit
  • Notification of Medicaid Hospice Benefit Election
  • Plan of Care
  • Ordering Forms
  • Form Retention and Submission
• Prior Authorization
  • Introduction
  • Prior Authorization for Personal Care Services
• Claims Submission
  • Introduction
  • Coordination of Benefits
  • 837 Health Care Claim: Institutional
  • UB-92
  • Billed Amounts
  • Billing Increments
  • Diagnosis Codes
  • Revenue Codes
  • Fee Schedule
• Reimbursement
  • Introduction
  • Nursing Home Room and Board
    • Introduction
    • Paper Adjustment Requests
  • Patient Liability
  • Hospice Cap on Overall Reimbursement
• Appendix
  • Appendix 1 — UB-92 (CMS 1450) Claim Form Instructions for Hospice Services
  • Appendix 2 — UB-92 Claim Form Sample
  • Appendix 3 — Physician Certification/ Recertification of Terminal Illness
  • Appendix 4 — Notification of Medicaid Hospice Benefit Election
  • Appendix 5 — Recipient Election of Medicaid Hospice Benefit
  • Appendix 6 — Hospice Benefit Revocation (Non-recertification)/ Voluntary Discharge
  • Appendix 7 — Allowable Revenue Codes for Hospice Care
  • Appendix 8 — Rounding Guidelines for Continuous Care
  • Appendix 9 — Services Provided Outside the Hospice Benefit
  • Appendix 10 — Sample Adjustment/ Reconsideration Request for Retroactive Nursing Home Rate Adjustment
• PDF

 

 

 

General Information

Hospice Recipient Requirements

Recipients Residing in Nursing Homes

When a resident of a Medicaid-certified SNF elects to receive hospice care services and the hospice has a contract with that nursing home, the provider is required to complete Section II of the Notification of Medicaid Hospice Benefit Election form (fillable PDF, 109 KB) and submit it to Wisconsin Medicaid. If a recipient enters a nursing home after admission to a hospice, the provider is required to complete Section III of the Notification of Medicaid Hospice Benefit Election form and submit it to Wisconsin Medicaid.

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