WAC 182-551-1315. Hospice certification process

(1) The following describes the hospice certification process: (a) When a client or the client's authorized health care representative elects to receive hospice care, the medicaid agency requires a hospice agency to: (i) Obtain a signed written certification from a physician of the client's terminal illness; or (ii) Document in the client's medical file that the hospice agency obtained verbal certification, followed up with a written certification signed by: (A) The medical director of the hospice agency or a physician staff member of the interdisciplinary team; and (B) The client's attending physician if the client has one; (iii) Place the signed written certification of the client's terminal illness in the client's medical file: (A) Within 60 calendar days following the day the hospice care begins; and (B) Before billing the medicaid agency for the hospice services. (b) For a subsequent election period, the medicaid agency requires a hospice physician or hospice nurse practitioner to: (i) Have a face-to-face encounter with every hospice client: (A) Within 30 calendar days prior to the 180th-day recertification; and (B) Prior to each subsequent recertification to determine continued eligibility of the client for hospice care; and (ii) Attest that the face-to-face encounter took place. (c) The hospice agency must: (i) Document in the client's medical file that it obtained a verbal certification, followed up with a written certification signed by: (A) The medical director of the hospice agency; or (B) A physician staff member of the hospice agency; (ii) Place the written certification of the client's terminal illness in the client's medical file before billing the medicaid agency for the hospice services; and (iii) Submit the written certification to the medicaid agency with the hospice claim related to the recertification. (2) The medicaid agency does not pay for face-to-face encounters to recertify a hospice client.