Purpose: To provide an overview of the Hospice program and explain how to correctly determine eligibility for Hospice
Hospice is a 24-hour intermittent program coordinated by a hospice interdisciplinary team for persons with a terminal illness and a prognosis of six months or less to live. The hospice program allows the terminally ill client to choose physical, pastoral/spiritual and psychosocial comfort, and palliative care rather than cure. Hospitalization is used only for acute symptom management.
Hospice care is initiated by the choice of the client, family or physician. The client’s physician must certify a client as appropriate for hospice care. Hospice can be ended at any time by the client or family (revocation) by the hospice agency (discharge) or by the death of the client (expired).
Hospice care may be provided in a client’s home, in a medical institution including a hospice care center, nursing facility, or in an alternate living facility.
For certain clients who are eligible for Categorically Needy (CN) coverage, hospice care is a service that is covered by their Provider One services card. Institutional Hospice rules may be used to provide CN coverage for these services, when it is to the advantage of clients. The L31 program is used if the client receives an SSI cash grant or L32 if the client is SSI-related and not otherwise eligible for CN.
Note: The N05 coverage group also provides hospice care for those who meet program requirements.
The L31/L32 hospice program is not a waiver program; however, rules that are similar to waiver program rules under WAC 182-515-1505 are used when countable income is under the Special Income Level (SIL). The special income level is 300% of the Federal Benefit Rate (FBR).
General eligibility for hospice programs
WAC 182-551-1000 General eligibility for hospice programs
- Definitions relating to hospice are in WAC 182-551-1010. A person must meet these general eligibility requirements:
- Verification of age and identity
- Citizenship or immigration status. Non citizen children are eligible to receive hospice services if they are eligible under a children's medical program
- Social Security Number
- Assignment of medical support rights
- Attains institutional status (WAC 182-513-1320). Institutional status is met when the HCA 13-746 hospice notification is received from the hospice agency with an election date indicated.
- Chapter 182-551 WAC describes the hospice program as a service
Alien Medical Program and Hospice
Clients receiving Alien Emergency Medical Program (AEMP) must have prior authorization for hospice services from the HCA Hospice Program Manager.
Note: Hospice services may be considered for noncitizen clients who are eligible for Alien Medical cancer and dialysis programs.
Indicate on the referral the request is for hospice for an AEM client on either the cancer or dialysis program. The request must be submitted within 5 business days of the client's election of hospice services.
Prior authorization for hospice is not required for clients enrolled in the state-funded long-term care program; however, the standard 5-day notification still applies.
Requests for prior authorization should be addressed to:
P.O. Box 45535
Olympia, WA 98504-5535
Note: Refer to Alien Medical Programs (AMP) for clients not meeting citizenship requirements and needing Hospice services. Hospice Providers must get preapproval from HCA in order to bill services under alien medical programs.