The Texas Department of Human Services (DHS) proposes to amend §30.14, concerning certification of terminal illness, §30.16, concerning election of hospice care, §30.20, concerning change of the designated hospice, §30.30, concerning requirements for participation as a Medicaid hospice provider, §30.54, concerning special coverage requirements, and §30.82, concerning sanctions, in its Medicaid Hospice Program chapter. The purpose of the amendments is to clarify existing language in the area of continuous home care and physician certification for terminal illness. Additional technical changes were made to correct numbering and addresses.

The proposal amends physician certification to reflect Medicare guidelines. Providers must ensure that eligibility forms are submitted before payment. Definitions for crisis and nursing services were added to the rule base, as well as additional documentation requirements for the description of the crisis and how the provider plans to resolve the crisis. Deadlines for review of the documentation submitted with an extension request were extended to 16 hours or 10 calendar days, depending on when the packet was mailed to DHS. DHS will consider one continuous home care extension request per each period of crisis. DHS may review continuous home care provided more than one time per month to the same recipient.

James R. Hine, Commissioner, has determined that for the first five-year period the proposed sections will be in effect, there will be no fiscal implications for state or local governments as a result of enforcing or administering the sections.

Mr. Hine also has determined that for each year of the first five years the sections are in effect, the public benefit anticipated as a result of adoption of the proposed rules will be additional accountability and consistency of service delivery among hospice providers. There will not be an effect on small or micro businesses as a result of enforcing or administering the sections because the rules do not require providers to do anything additional under current rule. There will be no anticipated effect on local employment in geographic areas affected by these sections.

Questions about the content of this proposal may be directed to Maxcine Tomlinson at (512) 438-3169 in DHS's Long Term Care Policy section. Written comments on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-060, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register .

Subchapter B. ELIGIBILITY REQUIREMENTS

40 TAC §§30.14, 30.16, 30.20

The amendments are proposed under the Human Resources Code, Title 2, Chapters 22 and 32, which authorizes the department to administer public and medical assistance programs, and under Texas Government Code, §531.021, which provides the Health and Human Services Commission with the authority to administer federal medical assistance funds.

The amendments implement the Human Resources Code, §§22.001-22.030 and §§32.001-32.042.

§30.14.Certification of Terminal Illness.

(a) Timing of certification.

(1) [ ~~Except as provided in paragraph (2) of this subsection, the~~ ] The hospice must obtain the oral [ ~~written~~ ] certification of terminal illness from a physician no later than two calendar days after the period begins.

(2) For the initial period, the physician(s) must sign and date the Medicaid Hospice Program Physician Certification of Terminal Illness form before the hospice submits an initial request for payment. The physician must sign and date the Medicaid Hospice Program Physician Certification of Terminal Illness form in all cases before the expiration date of each six-month certification period. Forms must be submitted by the hospice as outlined in §30.62 of this title (relating to Medicaid Hospice Claims Processing Requirements) and must be submitted before billing [ if the hospice cannot obtain the written certification within two calendar days, it must obtain oral certifications within two calendar days and written certification no later than eight calendar days after the period begins ].

~~[ ~~(3)~~ Upon receipt of the certification, hospice staff must:]~~

~~[ ~~(A)~~ make an appropriate entry in the patient's medical record as soon as they receive an oral certification; and]~~

~~[ ~~(B)~~ file written certifications in the medical record.]~~

(b) Content of certification. The certification must specify that the individual's prognosis is for a life expectancy of six months or less if the terminal illness runs its normal course. The certification statement must be based on record review or consultation with the referring physician.