CSHCN Services Program 2010 > Hospice > Benefits, Limitations, and Authorization Requirements

22.2.1 Prior Authorization Requirements

Prior authorization is required for hospice services. TMHP-CSHCN Services Program medical review staff review requests for hospice services. Hospice services may be prior authorized up to a maximum of 6 months per request.

Providers must submit the "CSHCN Services Program Prior Authorization Request for Hospice Services" form or the provider's plan of care (POC) if it includes the same information as the "CSHCN Services Program Prior Authorization Request for Hospice Services" form and the provider and physician signatures. All fields of the prior authorization form must be completed. A copy of the POC, signed and dated by a physician, must be maintained by the physician and hospice provider in the client's medical record. A copy of the "CSHCN Services Program Prior Authorization Request for Hospice Services" form is available in Appendix B on page B-39.

If the client requires hospice care beyond the initial 6-month period, authorization for additional 6-month periods may be considered with a new request that includes the following documentation:

•An updated "CSHCN Services Program Prior Authorization Request for Hospice Services" form or a POC that includes the same information as the "CSHCN Services Program Prior Authorization Request for Hospice Services" form and the provider and physician signatures.

•An updated description of all direct care, durable medical equipment (DME), supplies, and medications anticipated for the client's care.

Refer to: Section 4.3, "Prior Authorizations" for detailed information about prior authorization requirements.