General eligibility requirements that apply to all Apple Health programs

Contact hospice program eligibility

Revised Date: 
February 14, 2018

Program Administration - HCS and DDA LTC Specialty Unit

Home and Community Services (HCS) determines eligibility for hospice when clients are receiving services authorized by HCS.

HCS services include Medicaid Personal Care (MPC), Community First Choice (CFC), or HCS Home and Community Based (HCB) Waiver services authorized by the HCS social service specialist.

HCS determines eligibility for hospice when one spouse is receiving services from HCS and the other spouse is in need of hospice.

HCS does not retain nursing facility cases once a nursing facility client has made an election of hospice. Upon receipt of the notice of election in a nursing facility (NF), the HCS office makes a program change to the hospice program and transfers the case to the DDA LTC Specialty Unit. (CSO 017).

Example: Client is admitted to a nursing facility. Client elects hospice in the facility. Once a client has elected hospice, the nursing home service with HCS ends. The case changes from a L02 nursing home to a L32 hospice case by the HCS financial worker. The case is then transferred to the Hospice LTC Specialty Unit to be maintained by the hospice financial worker. The client is still residing in the nursing facility, but the funding is through the hospice program.

The hospice program is currently specialized within the DDA LTC Specialty Unit. The unit determines eligibility for the hospice program for clients who elect hospice services either at home, an alternative living facility, hospice care center, or nursing facility. If a client who is currently active on medicaid in an NF, the HCS office that maintains the case will update the hospice election and transfer the case to CSO 017 for ongoing maintenance.

The unit does not determine eligibility for clients who are currently receiving HCS HCB waiver services, CFC, or MPC. If a client who is currently receiving MPC or CFC services authorized by HCS, the HCS office that maintains the case will update the hospice election and transfer the case to CSO 017 for ongoing maintenance. If a client who is currently receiving HCS waiver services in home, the HCS office that maintains the case will update the hospice election and continue maintaining the case.

Contact information for Hospice within the DDA LTC Specialty Unit

DDA LTC Specialty Unit/Hospice Phone:

855-873-0642

Mail items for the DDA LTC Specialty Unit to:

PO Box 45826
Olympia WA 98504-5826

Fax items (not hospice election notices) for the DDA LTC Specialty Unit to:

855-635-8305

Fax hospice election notices:

360-725-1965

All hospice notifications statewide are faxed to the Health Care Authority's (HCA) MEDS unit where they are scanned into Barcode document management systems (DMS). A copy is sent to the HCA notification unit to update the client information in the claims payment system and a copy is also sent to the DDA LTC Specialty Unit or HCS office of record for review.

Note: Hospice agencies must send notices within 5 working days of election. If the Agency receives a hospice election notice later than 5 days of election for a client, the service authorization is not backdated. The HCS or DDA financial worker must contact Lori Rolley at HCS HQ, as HCA will need to adjust the provider payment.

Hospice Applications

Applications received requesting hospice only may be routed via DMS to the CSO 017 @ HSP for processing.

Applications for hospice received in the CSO that include requests for cash and food assistance are processed by the local CSO office.  Set a same day tickle to CSO 017 @HSP for application. The DDA LTC Specialty Unit will process the request for hospice medicaid coverage, if a hospice election is received.

Applications received where the client has requested hospice services are only handled by the DDA LTC Specialty Unit when there is an HCA 13-746 Hospice notification form in the client's record showing a current hospice election. If the client has indicated hospice on the application but no HCA 13-746 is in the client record, the DDA LTC Specialty Unit will contact the client, authorized representative or hospice agency to confirm whether the client has elected hospice or not, prior to denying the application for the hospice program or transferring the application to another office if other Medicaid or LTC services are requested.