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December 2016 Texas Medicaid Provider Procedures Manual

Section 4: Client Eligibility : 4.4 Restricted Medicaid Coverage : 4.4.3 Hospice Program

4.4.3
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.
Texas Medicaid clients who are 21 years of age and older and who elect hospice coverage waive their rights to all other Medicaid services related to their terminal illness. They do not waive their rights to Medicaid services that are unrelated to their terminal illness.
Texas Medicaid clients who are 20 years of age and younger and who elect hospice care are not required to waive their rights to concurrent hospice care and treatment of the terminal illness. They do not waive their rights to Medicaid services that are unrelated to their terminal illness.
Medicare and Medicaid clients must elect both the Medicare and Medicaid Hospice programs.
Concurrent hospice care and treatment services include:
Direct policy questions about the hospice program to DADS at 1-512-438‑3519. Direct all other general questions related to the hospice program, such as billing, claims, rate key issues, and authorizations to DADS at 1-512-438-2200.
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:

Texas Medicaid & Healthcare Partnership
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