General eligibility requirements that apply to all Apple Health programs

Hospice and long-term Services and Supports (LTSS) programs

Revised Date: 
February 14, 2018

LTSS programs (HCS and DDA HCB Waivers)

  • LTSS programs such as CFC, COPES, PACE, New Freedom and DDD Waiver programs take precedence over Hospice. ACES is coded under the primary HCB Waiver service and participation is applied toward the Waiver program first; the hospice service is added to the HCBS screen. It is important that services are coordinated between the Hospice provider and the DSHS agency providing services so there is no duplication of services.
  • For clients who elect hospice in a nursing facility, ACES is coded as hospice in a nursing facility on the institutional care screen under facilities and add the hospice service information in the HCBS screen. This will add the hospice indicator to the case; the case will trickle to a L31/L32.
  • Use the short stay screen for a hospice election in a NF when the client is already on Medicaid and the election and end of hospice service is under 30 days. 
  • Use the short stay screen for a hospice election when a client is active on a medicaid program and is admitted into a hospice care center or hospice NF admission 30 days or less.

Example: Active client on L02 in nursing home elects Hospice on 10/2/2017 and dies or revokes hospice on 10/15/2017. This case does not need to be changed in order to issue a hospice award letter. Use the short stay screen to issue a hospice award letter from 10/2/2017 to 10/15/2017.

Example: Active CFC client on L52 elects hospice.
The client remains in the ALF under the CFC program. The hospice agency will bill the medicaid agency with hospice as a service. The CFC program remains the priority program. The hospice service should be updated in ACES on the institutional care screen.

Example: Active L22 COPES client elects hospice; the client resides in their own home.

The hospice service should be updated in ACES on the institutional care screen along with the COPES service. The COPES Waiver is the priority program and participation would go to the COPES provider.