MLTC Policy 13.18(a):

Update MLTC Guidance on Hospice Coverage

  • Policy is also available in Portable Document Format (PDF)

Office of Health Insurance Programs

Division of Long Term Care

MLTC Policy 13.18(a): Update MLTC Guidance on Hospice Coverage

Date of Issuance: August 24, 2015

The purpose of this policy update is to provide new guidance regarding hospice services to MLTC enrollees.

Policy 13.18 indicates that any MLTC enrollee who requires hospice benefits may elect the benefit without disenrolling from MLTC. The policy also indicates individuals currently receiving hospice are excluded from enrolling in MLTC.

There are certain circumstances in which it would be appropriate for an MLTC enrollee receiving hospice benefits to transfer to another MLTC plan. Effective with the release of this policy, MLTC enrollees in receipt of hospice benefits will have the option to transfer to another MLTC plan and continue to retain access to hospice on a fee for service basis. Such enrollment will no longer be prohibited.

For example: if an MLTC enrollee is admitted to an out of network nursing home for a rehab stay and subsequently elects hospice and requires permanent placement, the enrollee would transfer to an MLTC plan that contracts with that nursing home.