SECTION 266.305. General Contracting Requirements

(a) A hospice participating in the Medicaid Hospice Program must comply with this chapter and applicable federal regulations and state rules, including 42 CFR Part 418; 26 TAC Chapter 558 (relating to Licensing Standards for Home and Community Support Services Agencies); and 40 TAC Chapter 49 (relating to Contracting for Community Services).

(b) A hospice participating in the Medicaid Hospice Program must not have restrictive policies or practices, including:

(1) requiring an individual to execute a will with the hospice named as legatee or devisee;

(2) assigning an individual's life insurance to the hospice;

(3) transferring an individual's property to the hospice;

(4) requiring an individual to pay a lump sum or make any other payment or concession to the hospice beyond the recognized Medicaid rate;

(5) controlling or restricting an individual or legal representative in using the individual's personal needs allowance while in a nursing facility or an ICF/IID;

(6) restricting an individual from transferring or withdrawing from the Medicaid Hospice Program at will, except as provided by state law;

(7) denying appropriate hospice care to an individual on the basis of the individual's race, religion, color, national origin, sex, age, disability, marital status, or source of payment; and

(8) preventing or requiring the execution of written or unwritten directives to reject life-sustaining procedures by an adult individual.

(c) If a hospice provides services to a resident of a nursing facility or an ICF/IID, the hospice must have a written contract for the provision of services with the nursing facility or ICF/IID.

(d) Medicaid hospice-nursing facility per diem rates. The Medicaid Hospice Program pays the Medicaid hospice provider a hospice-nursing facility rate that is no less than 95 percent of the Medicaid nursing facility rate for each individual in a nursing facility to take into account the room and board furnished by the facility. When the hospice-nursing facility rate is paid to the hospice provider, the Medicaid vendor payment to the nursing facility is not paid. Room and board services include the performance of personal care services, including assistance in the activities of daily living, in socializing activities, administration of medication, maintaining the cleanliness of a resident's room, and supervision and assisting in the use of durable medical equipment and prescribed therapies.

(e) Medicaid hospice-ICF/IID per diem rates. The Medicaid Hospice Program pays the Medicaid hospice provider a hospice-ICF/IID rate that is no less than 95 percent of the ICF/IID rate for each individual in an ICF/IID to take into account the room and board furnished by the facility. When the hospice-ICF/IID rate is paid to the hospice provider, the Medicaid vendor payment to the ICF/IID is not paid. Room and board services include the performance of personal care services, including assistance in the activities of daily living, in socializing activities, administration of medication, maintaining the cleanliness of a resident's room, and supervision and assisting in the use of durable medical equipment and prescribed therapies.

(f) Medicaid payments on Medicare coinsurance for drugs and biologicals. For Medicare-Medicaid individuals only, the Medicaid Hospice Program pays the Medicaid hospice provider a five percent coinsurance on prescription drugs and biologicals, not to exceed $5.00 per prescription.

(g) Medicaid payments for Medicare respite coinsurance. For Medicare-Medicaid individuals only, the Medicaid Hospice Program pays the hospice provider a five percent coinsurance for each day of respite care for up to five consecutive days of a hospice coinsurance period.

Source Note: The provisions of this §266.305 adopted to be effective July 26, 2022, 47 TexReg 4331