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4.3.4 Hospice Program
The Department of Aging and Disability Services (DADS) manages the Hospice Program through provider enrollment contracts with hospice agencies. These agencies must be licensed by the state and Medicare-certified as hospice agencies. Coverage of services follows the amount, duration, and scope of services specified in the Medicare Hospice Program. Hospice pays for services related to the treatment of the client's terminal illness and for certain physician services (not the treatments).
Medicaid Hospice provides palliative care to all Medicaid-eligible clients (no age restriction) who sign statements electing hospice services and are certified by physicians to have six months or less to live if their terminal illnesses run their normal courses. Hospice care includes medical and support services designed to keep clients comfortable and without pain during the last weeks and months before death.
When clients elect hospice services, they waive their rights to all other Medicaid services related to their terminal illness. They do not waive their rights to Medicaid services unrelated to their terminal illness. Medicare and Medicaid clients must elect both the Medicare and Medicaid Hospice programs. Individuals who elect hospice care are issued a Medicaid Identification (Form H3087) with "HOSPICE" printed on it. Clients may cancel their election at any time.
Direct policy questions about the hospice program to DADS at 1-512-438-3519.
DADS pays the provider for a variety of services under a per diem rate for any particular hospice day in one of the following categories:
• Routine home care.
•Continuous home care.
•Respite care.
•Inpatient care.
When the services are unrelated to the terminal illness, Medicaid (TMHP) pays its providers directly. For questions about hospice billing, call TMHP at 1-800-626-4117. Providers are required to follow Medicaid guidelines for prior authorization when filing claims to TMHP for hospice clients. Fax authorization requests to 1-512-514-4209.
Nonhospice providers may be reimbursed directly by TMHP for services rendered to a Medicaid hospice client.
Mail paper claims to the following address:
Texas Medicaid & Healthcare Partnership
PO Box 200105
Austin, TX 78720-0105
Appeal claims by writing to the following address:
Texas Medicaid & Healthcare Partnership
PO Box 200645
Austin, TX 78720-0645
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