Ohio Administrative Code|Rule 5160-56-03.3 | Hospice services: reporting requirements.

                                                
This rule sets forth the requirement for recording
		the hospice provider span for individuals receiving medicaid hospice care in
		accordance with Chapter 5160-56 of the Administrative Code, including
		individuals who may be covered by third-party insurance, such as medicare, for
		which the hospice seeks reimbursement.
(A) The designated hospice shall report
		  the required enrollment information to the Ohio department of medicaid using
		  the medicaid information technology system (MITS) for the
		  following:
(1) Individuals in
			 fee-for-service (FFS) medicaid hospice under the designated hospice's care
			 on the effective date of this rule; and
(2) Individuals in which
			 the hospice seeks to file an original or adjusted claim to ODM for medicaid
			 hospice services rendered under codes T2042 and T2046, including:
(a) All individuals with FFS claims for routine home care,
				code T2042, for the dates of service on or after January 1, 2016 ,whether or
				not the claim has previously been submitted and paid.
(b) Individuals in the care of hospice prior to the
				effective date of this rule, if the provider is submitting an original FFS
				claim for hospice services other than the services specified in paragraph
				(A)(2)(a) of this rule.
(c) Individuals in the care of hospice prior to the
				effective date of this rule, if the provider is submitting an adjusted FFS
				claim or if ODM must adjust a FFS claim for hospice services other than the
				services specified in paragraph (A)(2)(a) of this rule.
(B) The designated hospice shall ensure the following
		  information is entered into MITS prior to submitting a claim for
		  reimbursement:
(1) The individual's
			 recipient identification number (also referred to as the medicaid billing
			 number) as shown on the individual's medicaid card;
(2) The date the
			 individual elected hospice; 
(3) The begin date and
			 end date of every benefit period recognized under paragraph (D) of rule
			 5160-56-02 of the Administrative Code. For each benefit period, the designated
			 hospice shall identify the benefit period as either the initial one time
			 ninety-day period, the subsequent one time ninety-day period, or one of the
			 subsequent unlimited sixty-day periods as applicable;
(4) The national provider
			 identifier for the medical doctor who serves on the hospice interdisciplinary
			 group (IDG) for each benefit period;
(5) The national provider
			 identifier for the attending physician or the advanced practice registered
			 nurse for each benefit period;
(6) The oral
			 certification date(s), if applicable;
(7) The written physician
			 certification date(s);
(8) The hospice terminal
			 illness diagnosis code(s); 
(a) At least one but not more than three terminal diagnosis
				codes for the individual;
(b) The effective dates (begin and ending date) that apply
				to the terminal diagnosis code(s) shall be entered in MITS by the designated
				hospice;
(9) The county (or
			 counties if more than one) where hospice services were or will be provided
			 during the benefit period;
(10) The national
			 provider identifier of the long term care facility (LTFC) and the corresponding
			 effective date and end date, if the individual resides in a LTCF and provider
			 will be billing for hospice room and board services;
(11)  Supporting documentation, as
			 required to be attached to the claim, including:
(a) Copy of the current certification of the terminal
				illness;
(b) Copy of the individual's election
				statement;
(12) The date of death, when applicable;
			 and
(13) Any updates or changes to be made to
			 the benefit period as a result of a discharge pursuant to rule 5160-56-03 of
			 the Administrative Code.
(C) The information specified in paragraph (B) of this rule
		  shall be submitted to ODM only through the system in accordance with the
		  requirements of the MITS system.