37.40.815 HOSPICE, ELECTION AND WAIVER OF OTHER BENEFITS
(1) A beneficiary eligible for hospice care or their representative must file an election statement with a particular hospice in order to receive such care. The department will follow Medicare regulations and guidelines in administering this provision, including 42 CFR 418.20 through 418.30.
(2) A beneficiary waives all rights to Medicaid payments for the duration of the election of hospice care for the following services:
(a) Hospice care provided by a hospice other than the hospice designated by the beneficiary (unless provided under arrangements made by the designated hospice).
(b) Any Medicaid services that are related to the treatment of the terminal condition for which hospice care was elected or a related condition or that are equivalent to hospice care except for:
(i) services provided by the designated hospice;
(ii) services provided by another hospice under arrangements made by the designated hospice; and
(iii) services provided by the beneficiary's attending physician if that physician is not an employee of the designated hospice or receiving compensation from the hospice for those services.
(3) The hospice chosen by the eligible beneficiary, or their representative, must file the original Notice of Election (NOE) or a copy, with the department within five calendar days of the start of Medicaid Hospice Services. NOEs must be sent to the Senior & Long Term Care Division, 1100 N. Last Chance Gulch, P.O. Box 4210, Helena, MT 59604-4210. The department may waive the consequences of failure to submit a timely filed NOE. A hospice must fully document and furnish any requested documentation to the department for a determination of exception.
(4) When the hospice election is ended due to discharge, the hospice must file a Notice of Termination of Election with the department within five calendar days after the effective date of the discharge, unless it has already filed a final claim for that beneficiary. Notice of Terminations must be sent to the Senior & Long Term Care Division, 1100 N. Last Chance Gulch, P.O. Box 4210, Helena MT 59604-4210.
History: 53-6-113, MCA; IMP, 53-6-101, MCA; NEW, 1989 MAR p. 842, Eff. 7/1/89; AMD, 1990 MAR p. 539, Eff. 3/16/90; TRANS, from, SRS, 2000 MAR p. 489; AMD, 2016 MAR p. 1167, Eff. 7/9/16; AMD, 2018 MAR p. 1288, Eff. 7/7/18; AMD, 2020 MAR p. 93, Eff. 1/18/20; AMD, 2022 MAR p. 1672, Eff. 8/6/22.