Section R414-14A-4 - Program Access Requirements(1) The hospice agency must operate and furnish services in compliance with applicable federal, state, and local laws and regulations related to the health and safety of patients.(2) The hospice agency must be licensed with the state, Medicare-certified in accordance with 42 CFR 418, and an enrolled Medicaid provider before initiating hospice services. At the time of a change of ownership, the previous owner's provider agreement terminates as of the effective date of the change of ownership.(3) Medicaid accepts waivers granted to hospice agencies by the Centers for Medicare and Medicaid Services (CMS) as part of the Medicare certification process.(4) If a member who resides in a nursing facility, ICF/ID, or a freestanding hospice inpatient facility elects to receive hospice benefits, the hospice agency and the facility must have a written agreement in which a comprehensive service plan specifies the total care of the member.(a) The agreement must outline that the hospice agency is responsible for the professional management of the member's hospice care.(b) The facility agrees to provide room and board and services unrelated to the care of the terminal condition of the member.(5) The agreement must include the following: (a) identification of the services to be provided by the hospice agency and the facility as well as the method of care coordination to ensure services are consistent with the hospice approach to care and are organized to achieve the outcomes defined by the hospice plan of care;(b) a stipulation that services may be provided only with the express authorization of the hospice agency;(c) how the contracted services are coordinated, supervised, and evaluated by the hospice agency;(d) the delineation of the roles of the hospice agency and the facility in the admission process that includes an assessment process, an interdisciplinary team care conference, and a service planning process;(e) requirements for documenting that services are furnished following the agreement;(f) the qualifications of the personnel providing the services; and(g) the billing and reimbursement process by which the facility will bill the hospice agency for room and board to receive reimbursement from the hospice agency.Utah Admin. Code R414-14A-4
Amended by Utah State Bulletin Number 2022-20, effective 9/30/2022