Chapter 514 - Nursing Facility Services - DHHR - State of West ...

nursing facility cannot charge Medicaid a bed hold if the resident is under the Hospice benefit.The bed hold is to be contracted between nursing facility and the approved Hospice provider.A significant change in status assessment (SCSA) is required to be performed when aterminally ill resident enrolls in a hospice program (Medicare Hospice or other structuredhospice) and remains a resident at the nursing home. The assessment reference date (ARD)must be within 14 days from the effective date of the hospice election (which can be the sameas or later than the date of the hospice election statement, but not earlier). A SCSA must beperformed regardless of whether an assessment was recently conducted on the resident. This isto ensure a coordinated plan of care between the hospice and nursing home is in place.A Medicare-certified hospice must conduct an assessment at the initiation of its services. This isan appropriate time for the nursing home to evaluate the MDS information to determine if itreflects the current condition of the resident, since the nursing home remains responsible forproviding necessary care and services to assist the resident in achieving his/her highestpracticable well-being at whatever stage of the disease the resident is experiencing.A SCSA is required to be performed when a resident who is receiving hospice services decidesto discontinue those services (known as revoking of hospice care). The ARD must be within 14days from one of the following:The effective date of the hospice election revocation (which can be the same as or laterthan the date of the hospice election revocation statement, but not earlier);The expiration date of the certification of terminal illness; orThe date of the physician’s or medical director’s order stating the resident is no longerterminally ill.If a resident elects the hospice program, it is important that the two separate entities (nursinghome and hospice program staff) coordinate their responsibilities and develop a care planreflecting the interventions required by both entities. The nursing home and hospice plans ofcare should be reflective of the current status of the resident. In addition to coordinating plansof care between the nursing facility and the hospice provider, the two entities must alsocoordinate billing procedures for these members, which should include but is not limited to, theproration of patient resource amounts. When nursing facility residents are receiving hospicecare, the nursing facility cannot bill Medicaid for the days that the member is receiving hospiceservices. The hospice provider is responsible for billing Medicaid. When a nursing facilityresident is receiving hospice services for a partial month, the patient resource amount may needto be prorated. For example, a member is admitted to the nursing facility on January 1 st andremains in the facility for the entire month and then on January 11 th , the member elects hospiceservices in the nursing facility and continues to receive the hospice services through January31 st . The nursing facility would prorate the resource amount for the January claim for 10days. The hospice claim would reflect a prorated resource amount for 21 days. If the nursingfacility resident is receiving hospice services for the entire month, the full resource amount willbe deducted from the payment made to the hospice provider for room and board.Department of Health and Human Resources Chapter 514: Nursing Facility Services Page 49January 1, 2013DISCLAIMER: This manual does not address all the complexities of Medicaid policies and procedures,and must be supplemented with all State and Federal Laws and Regulations.