Long haul Care Division

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Long haul Care Division. Alabama Medicaid Organization Long haul Care Division Effort and Training Unit Reexamined: July 2004. P R E S E N T S. A Review of HOSPICE Consideration. HOSPICE CARE.

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Long haul Care Division Alabama Medicaid Agency Long Term Care Division Outreach and Education Unit Revised: July 2004

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P R E S E N T S An Overview of HOSPICE CARE

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HOSPICE CARE Hospice care is characterized as administrations which are fundamental for the concealment or administration of the terminal sickness and related conditions.

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LEVEL OF CARE DETERMINATION The going to doctor or hospice medicinal executive ensures the beneficiary has a terminal ailment and requires administrations that are restoratively important for palliative care. Accreditation of the terminal sickness of a person who chooses the hospice advantage might be founded on the doctor's clinical judgment with respect to the typical course of the individual's disease.

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LEVEL OF CARE DETERMINATION Certification of terminal ailment must incorporate particular discoveries and therapeutic documentation including, yet not constrained to, restorative records, lab, x-beams, pathology reports, and so on

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HOSPICE ELECTION AND CERTIFICATION If the beneficiary is dually qualified for Medicare and Medicaid, the hospice advantage must be chosen all the while. The Medicaid Hospice Election Form 165 must be finished. Frame 165

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HOSPICE ELECTION AND CERTIFICATION The shape ought to demonstrate if the individual is a Medicare beneficiary and if the beneficiary is in a nursing office. The Hospice Election Form ought to be marked and dated by the patient or the patient's illustrative.

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HOSPICE ELECTION AND CERTIFICATION The mark or characteristic of the patient or the patient's illustrative mark ought to be seen and dated by the hospice supplier specialist getting the marks. The doctor must sign and date the frame with the date the mark is acquired.

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HOSPICE ELECTION AND CERTIFICATION The doctor's mark must be a unique (white-out or CRNP marks are not worthy). The date of the doctor's mark must be inside 2 logbook days of the race date unless there is a verbal request got for start of care.

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HOSPICE ELECTION AND CERTIFICATION If there is a verbal request the doctor's mark and date must be inside 8 days of the decision date. All ensuing advantage periods must be confirmed in composing inside 2 schedule days . In the event that the beneficiary has Medicare Part A, the LTC Admission Notification Form ought not be transmitted to EDS. In this example, Medicare would be the payor for hospice benefits.

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SUBMISSION OF LONG TERM CARE NOTIFICATION FORM Financial qualification is confirmed Hospice Provider transmits the LTC Admission Notification Form to EDS electronically The transmission will be acknowledged or dismisses

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SUBMISSION OF LONG TERM CARE NOTIFICATION FORM An acknowledged transmission will be the suppliers record of endorsement for Hospice administrations If there are dismissals, the supplier must make the fundamental rectifications and resubmit the LTC Admission Notification Form

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TRANSFERS An individual or agent may change, once in every race period, the assignment of the specific hospice from which care will be gotten.

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TRANSFERS To change the assignment of the hospice supplier, the individual or delegate must record a marked articulation that incorporates the accompanying: 1. The name of the hospice from which mind has been gotten. 2. The name of the hospice from which the singular arrangements to get mind. 3. The viable date of the exchange.

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TRANSFERS The past hospice supplier would present a release. The new hospice supplier would finish the Medicaid Hospice Election Form 165.

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REVOCATION Notices of denial or demise ought to be submitted to the LTC File inside 48 hours. On the off chance that the beneficiary is ensured by the Medicaid District Office (DO), the DO must be informed of lasting changes, for example, denies with no aim to return, or the passing of the person.

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HOSPICE IN A NURSING FACILITY Hospice suppliers may send the Medicaid Hospice Election (Form 165) to the DO, when applying for money related qualification. This shape demonstrates to the DO that the customer meets the level of care criteria.

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SSI Recipients Transitioning from Home to Institution SSI must be told of the people change of living arrangement so the individual's salary might be balanced in like manner.

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Retrospective Review Process

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RETROSPECTIVE REVIEW POLICY To guarantee that state and government tenets and rules are clung to by long haul mind suppliers, the Alabama Medicaid Agency (AMA) will reflectively survey month to month a 25% example of confirmations, re-affirmations and re-conclusions of Medicaid beneficiaries served by long haul mind suppliers.

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RETROSPECTIVE REVIEW PROCESS The AMA proficient nursing and medicinal staff will lead review surveys of long haul mind suppliers on a month to month premise. Every supplier will be informed of records to either mail into the Medicaid Agency or to have accessible for on location survey. The AMA won't be in charge of any cost related with the replicating or mailing of asked for reports.

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RETROSPECTIVE REVIEW PROCESS...CONTINUED The AMA proficient staff will audit asked for reports to guarantee consistence with government and state rules representing the Hospice program and to guarantee the restorative need of the administrations rendered. The audit must be finished by the AMA inside 30 days from receipt of the asked for data from the long haul mind supplier.

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RETROSPECTIVE REVIEW PROCESS...CONTINUED The supplier must bend over backward to send all asked for data upon the primary demand. An agenda will be given to guarantee that all archives are incorporated before mailing. Customer records which are resolved to be lacking of asked for archives or if the restorative requirement for the administrations can't be discovered, might be suggested for recoupment.

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RETROSPECTIVE REVIEW PROCESS...CONTINUED The AMA may start a moment demand to suppliers for the asked for data or extra data. On the off chance that this data is not gotten, recoupment procedures will be started.

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RETROSPECTIVE REVIEW PROCESS...CONTINUED Upon survey of the asked for archives, the supplier will be told in composing inside 30 days if additionally move will be made or if extra data is required. Suppliers might be told if additionally activity is vital.

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RETROSPECTIVE REVIEW PROCESS...CONTINUED Providers will be advised of their allure rights including the casual reexamination, and additionally a reasonable hearing procedure.

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Recoupment Procedures

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RECOUPMENT PROCESS The Alabama Medicaid Agency's (AMA) Long Term Care Admissions/Records Unit will play out a review audit of long haul mind projects, readmissions, and re-conclusions.

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RECOUPMENT PROCESS...CONTINUED Records asked for amid the review audit process will be evaluated by the Alabama Medicaid Agency's expert staff to guarantee consistence with state and government rules overseeing the particular program, and to guarantee the restorative need of the administrations rendered.

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RECOUPMENT PROCESS...CONTINUED If upon audit, it is resolved that the archives meet all state and government prerequisites and that the medicinal need of the administrations is reported, no further move will be made by the Medicaid Agency. The suppliers won't get further notice from Medicaid in these examples.

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RECOUPMENT PROCESS...CONTINUED If upon survey, it is resolved that the archives neglect to meet all state and government prerequisites or that the documentation submitted does not bolster the restorative need of the administration, the Alabama Medicaid Agency will start recoupment of assets paid for administrations rendered.

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RECOUPMENT PROCESS...CONTINUED The Alabama Medicaid Agency proficient nursing and therapeutic staff will survey any extra documentation submitted inside the assigned time allotments to figure out whether the data submitted fulfills the AMA's worries.

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RECOUPMENT PROCESS...CONTINUED If it is resolved that the records meet all state and government prerequisites and that the restorative need of the administration is archived, no further recoupment move will be made. The AMA will tell the supplier in composing inside 30 days from receipt of the extra data of this choice.

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RECOUPMENT PROCESS...CONTINUED If it is resolved that the documentation does not fulfill the AMA concerns, the supplier will be told in composing inside 30 days from receipt of the extra data and their entitlement to a reasonable hearing.

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RECOUPMENT PROCESS...CONTINUED If the supplier's demand for a casual interest or reasonable hearing is not gotten convenient, the privilege to offer will be relinquished. On the off chance that after the sum total of what advances have been depleted, the AMA keeps on contradicting the supplier's dispute that all necessities are fulfilled, the AMA will continue with recoupment activities.

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RECOUPMENT PROCESS… CONTINUED The Long Term Care Admissions/Records Unit will forward data to the Long Term Care Provider/Recipient Services Unit to continue with the recoupment procedure.

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Hospice in the Nursing Home

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HOSPICE IN THE NURSING HOME Medicaid won't limit hospice administrations in light of a patient's place of living arrangement. A nursing office inhabitant may choose to get hospice benefits in the event that he or she meets the prerequisites for hospice mind under the Medicaid Program.

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HOSPICE IN NURSING HOMES If the occupant chooses to get hospice benefits, the nursing home ought to present the application to release the inhabitant from the nursing home and admit to hospic

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