DADS released three information letters:
Hospice:
Hospice providers are responsible for know the Medicare and Medicaid eligibility for a hospice client. An excerpt:
The DADS rule for Medicaid Hospice Payments and Limitations at 40 TAC §30.60(h) states:
(h) Third-party resources. Medicaid pays only after all third-party resources have been used.
In accordance with 40 TAC §30.60(h), it is the responsibility of the hospice provider to be aware of a client’s eligibility for Medicare Part A when a client elects hospice. Additionally the hospice provider is responsible for being aware of any Medicare Part A eligibility for the client through the entire hospice period of care to avoid recoupment of Medicaid payments of hospice services covered by Medicare.
Subsequently, if the hospice provider bills Medicaid for services when the client is Medicare eligible, Medicaid services will be recouped. Clients enrolled in Medicare who have service authorizations for Service Codes 1 and 30 will be cancelled effective the date of Medicare enrollment and any Medicaid paid services for the Service Codes 1 and 30 for the time period covered by Medicare will be recouped by DADS. Hospice providers will be given the opportunity to dispute the recoupment of the hospice services by providing documentation concerning Medicare enrollment dates and/or denials of billings to Medicare for the services in question. Upon receipt of the documentation, DADS will evaluate the denial and circumstances to determine the Medicaid liability.
States are required to provide hospice care concurrently with treatment services for individuals under 21 enrolled in SCHIP. Effective August 1, 2010, a family electing to receive hospice care for such an individual is no longer required to waive treatment for the terminal illness. (Letter)
NFs:
DADS reminded these providers they’re required to submit copies of all Form 3618 Resident Transaction Notices and Form 3619 Medicare/Skilled Nursing Facility Patient Transaction Notices to the appropriate HHSC Medicaid Eligibility for the Elderly and People with Disabilities specialist. (Letter)
