Hospice and MAPC

Some questions recently came up regarding MAPC when consumers are receiving Hospice.

A few things to point out:

  • If a person is receiving MAPC, CLA must learn of Hospice immediately, as they have a 7-day window to submit a Nursing Plan of Care and Amendment. It is very important to tell CLA when Hospice is being brought in (or even being considered, so they can have a heads-up).
  • CLA cannot add any hours once Hospice begins per MAPC regulations. If the consumer needs more personal care due to their condition, CLA cannot write a new PCST for those hours.
  • A consumer’s authorized MAPC hours will not go up when in hospice; however, they can decrease if the annual MAPC assessment is due while consumer has in-home hospice. Hospice is “required” to provide the added assistance as needed.
  • Hospice is required to provide any additional personal cares needed because of the terminal illness. This is a point that Support Brokers can use with Hospice.

Please see the below excerpt from the MAPC handbook regarding personal care services and the Hospice benefit:

Personal Care Services and the Hospice Benefit

Members receiving personal care who elect the hospice benefit may be eligible to continue receiving personal care services from the personal care agency if those services are not directly related to the terminal illness.

If this criterion is met, the agency providing personal care services will have already received PA (prior authorization) for the member. The personal care agency is required to submit a Prior Authorization Amendment Request (F-11042 ()) form and attach a copy of the hospice POC (plan of care) that identifies the need for continued personal care services as well as the specific services provided directly by the hospice. The POC must also indicate any aide services to be provided by the hospice. This must be sent within seven calendar days of the member’s election of hospice care. When the personal care PA needs to be renewed, a current hospice POC must be included. Renewal of PA for personal care services may be granted up to, but not exceeding, the current LOS (level of service). Additional personal care needs resulting from the terminal illness are the responsibility of the hospice.

Topic #2458

Reimbursement

Personal care agencies should continue to bill for services the same as before the member began hospice care. For example, a member is a quadriplegic as a result of an automobile accident and has been receiving personal care services. The member is then diagnosed with terminal cancer and elects the hospice benefit. Wisconsin Medicaid will continue to reimburse the personal care provider for the PC required in connection with the quadriplegia with an amended PA, including a hospice POC (plan of care), identifying the continued need for that service. When the member requires additional PC due to the terminal illness, the hospice is responsible.

Wisconsin Medicaid Personal Care Published Policy Page 219 of 309