• 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 Enrollment

A Medicaid recipient is eligible for hospice services if the following conditions are met:

1. A physician certifies that the recipient has a terminal illness that reduces his or her life expectancy to six months or less if the terminal illness runs its normal course. The physician accomplishes this by completing a Physician Certification/Recertification of Terminal Illness form, HCF 1011 (fillable PDF, 67 KB), and retaining a copy in the recipient’s records. Refer to the Required Documentation chapter of this handbook for more information and to Appendix 3 of this handbook for the Physician Certification/Recertification of Terminal Illness form.
2. The recipient elects the hospice benefit and waives regular Medicaid benefits for care and/or treatment of the terminal illness or related condition. The recipient indicates this election by completing and signing the Recipient Election of Medicaid Hospice Benefit form, HCF 1009 (fillable PDF, 74 KB). Refer to the Required Documentation chapter of this handbook for more information and to Appendix 5 of this handbook for the Recipient Election of Medicaid Hospice Benefit form.
3. The hospice notifies Wisconsin Medicaid of the recipient’s hospice election by completing and sending in the Notification of Medicaid Hospice Benefit Election form, HCF 1008 (fillable PDF, 109 KB). Refer to the Required Documentation chapter of this handbook for more information and to Appendix 4 of this handbook for the Notification of Medicaid Hospice Benefit Election form.
4. The attending physician and the interdisciplinary team establish a written POC before hospice services are provided. Refer to the Required Documentation chapter of this handbook for more information.

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