Hospice and home and community-based services (HCBS) authorization process
Page posted: 8/3/26
The hospice benefit is a comprehensive package of services that offers palliative care support to terminally ill people and their family. Hospice is an entirely voluntary choice for the person. For more information about hospice choice, providers and covered services, refer to MHCP Provider Manual – Hospice services. For information about hospice and HCBS, refer to CBSM – Hospice.
Case manager approval of HCBS
People can receive hospice and also be on a waiver, Alternative Care (AC) or Essential Community Supports (ECS). They may be open to the HCBS program before hospice, or they may open after they choose hospice.
To authorize hospice:
1. Work with the hospice provider agency to review the hospice care plan and the waiver/AC/ECS support plan to identify possible service duplication.
2. Add comments on the DHS comment screen of the service agreement to document this coordination and confirm there is no service duplication. The notes must indicate why the services are necessary (i.e., the person currently receives the services, or the services are new but address a condition not related to the terminal condition).
Exception code 233
MMIS will post forcible exception code 233 on the service agreement to indicate that the person has elected the hospice benefit. This exception code reminds you of the need to coordinate with the hospice provider agency and complete required documentation on the DHS comments screen of the service agreement. When you force this exception code, your worker ID is listed to indicate that you are the worker who confirmed the coordination was completed.
Waiver, AC and ECS claims with hospice
A claim exception code suspends the HCBS claim when the date of service overlaps with the hospice benefit period. The hospice provider is the primary payer of services, so DHS must manually review claims to determine if payment is appropriate.
DHS will review your case management notes on the DHS comment screen to ensure you coordinated with the hospice provider. DHS will pay claims if the coordination process has occurred. If it appears that coordination with the hospice provider has not occurred, DHS will either deny the claim or keep the claim in suspense until the coordination process is completed.
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