The Situation Report | June 26, 2023
On Wednesday June 15, 2023 the New York State Department of Health (NYSDOH), Office of Health Insurance Programs, Division of Health Plan Contracting and Oversight, issued effective immediately, Managed Long Term Care Policy 23.02 to provide Medicaid Managed Care Organizations (MMCOs) guidance and instructions regarding coordination of hospice services.
With managed care and hospice as principal members in the HCA membership, HCA is concerned with the obligations and impacts of 23.02 on both MLTCs and hospices, particularly in combination with DAL DHCBS 22-15 previously issued to hospice providers.
Since the issuance of 22-15, HCA has expressed strong concerns to NYSDOH about its potential adverse impact on hospice operations, staff and patient access. We noted the burden it placed on providers to complete and distribute the form; how hospices may be unaware of all of the non-hospice services that individuals are receiving; and the potential “chilling” effect on already low utilization of hospice services. Moreover, we have stated concerned about the impact of 22-15 as it relates to care and services provided to individuals collaboratively served by hospice and MLTCs.
The form and its effect on patient care was discussed at two subsequent HCA Hospice and Palliative Care Forums and HCA requests that both MLTC and hospice members communicate their comments about 23.02 and 22-15 as soon as possible to Arianna Stone at astone@hcanys.org.
According to DOH, adherence to this policy is necessary so that it can identify New York State (NYS) Medicaid recipients’ hospice participation to prevent any duplication of services that are in Medicare hospice and certain manage long term care (MLTC) products. Please note that certain hospice services are covered outside of the MLTC Partial and Medicaid Advantage Plus (MAP) benefit packages through fee-for-service (FFS).
You can view all Medicaid Enrolled Hospice Providers here.
Identifying Medicaid Recipients in Receipt of Hospice Care: A new Recipient Restriction/Exception (RR/E) code, C2-HOSPICE-MM, has been developed to recognize Medicaid recipients who elect to receive hospice care. This code is systematically added to a dual eligible Medicaid recipient’s record and returned on the ePACES eligibility response. It will also be added to the 834 file when a hospice election period is received on the Medicare Modernization Act (MMA) file.
The MMA file includes:
- Medicare Parts A, B, C, and D eligibility and enrollment data including the hospice election date period.
- For non-dual Medicaid recipients, the C2 R/E code needs to be manually added to the recipient’s record.
When the MMCO becomes aware of a dual or non-dual Medicaid recipient receiving hospice car,e the MMCO is required to verify that the recipient’s eMedNY file appropriately indicates that the recipient is receiving hospice services. If it does not indicate that the recipient is receiving hospice services, the MMCO must request that DOH add the C2 R/E code. MMCOs can achieve this by completing Attachment 1 and emailing it to hospicebilling@health.ny.gov via a HIPAA compliant email with the subject: Hospice C2 R/E Code Needed MMCO.
When the MMCO becomes aware of a dual or non-dual Medicaid recipient has withdrawn their hospice election, the MMCO must verify that the C2 R/E code Thru Date in eMedNY coincides with the end date of their hospice election. If it has not been end-dated, or the end date is incorrect the MMCO must complete Attachment 1 and email it to hospicebilling@health.ny.gov via a HIPAA compliant email with the subject: Hospice End-Date Needed MMCO.
Medicaid FFS recipients receiving hospice services are excluded from enrolling in Medicaid managed care including Mainstream, Health And Recovery Plans (HARP), HIV Special Needs Plan, MLTC Partial Capitation, Medicaid Advantage Plus (MAP), Programs for All-Inclusive Care for the Elderly (PACE), and Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD).
However, Medicaid managed care enrollees, excluding PACE enrollees, who receive hospice care may remain enrolled in the managed care plan of their choice for the duration of their hospice election.
Coordination of Hospice Services: When Medicaid managed care recipients are provided hospice services, the MMCOs are responsible for coordinating services and financial obligations with the hospice provider, specifically for any personal care and/or consumer directed personal assistance services (CDPAS) and Durable Medical Equipment and supplies.
In an effort to support this coordination, NYSDOH issued DAL DHCBS 22-15 which instructs hospice providers to complete form DOH-5778, “Entity/Facility Notification of Hospice Non-Covered Items, Services, and Drugs.” Hospice providers are also required to share the form with other healthcare providers, Local Departments Social Services (LDSS), and MMCOs, and those from whom the hospice recipient may receive items, services, or drugs.
MMCOs are required to:
- Ensure receipt of DOH-5778 from the hospice provider, documenting in their records when DOH-5778 was received.
- Incorporate the DOH-5778 into their records for appropriate care planning throughout the duration of treatment and be able to provide the form upon request of DOH and/or other entities (e.g., the Office of the Medicaid Inspector General, Centers for Medicare and Medicaid Services, etc.) for purposes of audit and/or surveillance to ensure there are no overlaps in services.
- Document in their progress/case notes the reason a service is provided outside of the hospice benefit (e.g., diagnoses, medical conditions) not related to the recipient’s terminal illness.
Any questions related to Managed Long Term Care Policy 23.02 should be directed to hospicebilling@health.ny.gov.
NYSDOH has also posted a General Information System notice for Local Departments of Social Services on the coordination of hospice services for FFS recipients and Medicaid managed care enrollees. That guidance also includes a list of allowed and disallowed services.