Hospice Agencies & Residences

State Operations Manual (SOM) Chapter 2

SOM Appendix M for Hospice Regulations

SOM Appendix Z Emergency Preparedness

To voluntarily become a Medicare certified provider, you will need to complete the following steps and submit the paperwork electronically to LARA-BSCSupport@michigan.gov, unless otherwise noted in the instructions.

• Complete Provider Enrollment Application (CMS-855A) and submit to Medicare Administrative Contractor (MAC). The MAC will provide you a recommendation letter once the initial review is complete.
• An e-mail confirming a successful electronic submission of your Civil Rights Clearance for Medicare Provider Certification from the Office for Civil Rights (OCR).
• A signed "Health Insurance Benefit Agreement" (CMS-1561).
• Currently, CMS has prioritized initial surveys as a lower tier work.  Following the guidance of the CMS Mission and Priority Document, Michigan is currently not performing initial surveys.  A provider can become accredited to obtain certification.
• Contact Accrediting Organization (AO) to schedule survey.
• Once the deeming survey is complete, please ensure the Department of Licensing and Regulatory Affairs (LARA), Bureau of Survey and Certification (BSC) receives a copy of the survey report and final approval letter from your deeming authority.
• Once all of the above documents have been received your application will be deemed complete and our office will review and forward the packet to the MAC for final determination and issuance of the Medicare provider number.
• Please note, this process can take up to 30-60 days from the day of receipt by the MAC.

• Complete Provider Enrollment Application (CMS-855A) and submit to MAC within 90 days of the move.
• The MAC will provide you a recommendation letter once the initial review is complete.
• Complete Application for Multiple Location and submit to LARA-BSCSupport@michigan.gov.
• For deemed providers, please submit the accrediting agency survey report that includes the new site(s).
• Once all of the above documents have been received and deemed complete, Bureau of Survey and Certification will review and forward the packet to the MAC for final determination and issuance of final approval letter.
• Currently, additional practice location reviews are Tier 4 work according to the CMS Mission and Priority Document (MPD).Please be aware that onsite survey work takes priority over this type of request.
• *Note-multiple locations are not state licensed, however hospice residences do require state licensing for each location.

The situations under which a hospice may discharge a patient are addressed in the regulation at 42 CFR 418.26 and include the following situations:

• The patient moves out of the hospice’s service area or transfers to another hospice;
• The hospice determines that the patient is no longer terminally ill; and
• The hospice determines under a policy set by the hospice for the purpose of addressing discharge for cause, that the patient’s (or other persons in the patient’s home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or the ability of the hospice to operate effectively is seriously impaired. 

The hospice must do the following before it seeks to discharge a patient for cause:

• Advise the patient that a discharge for cause is being considered;
• Make a serious effort to resolve the problem(s) presented by the patient’s (or other persons in the patient’s home) behavior or situation;
• Ascertain that the patient’s proposed discharge is not due to the patient’s use of necessary hospice services; and
• Document in the clinical record, the problem(s) and efforts made to resolve the problem(s). 

Prior to discharging a patient for any reason stated above, the hospice IDG must obtain a written physician’s discharge order from the hospice medical director. If a patient has an attending physician involved in his or her care, this physician should be consulted before discharge and his/her review and decision included in the discharge note.

NOTE:  The hospice notifies its Medicare administrative contractor (MAC) and SA of the circumstances surrounding the impending discharge.