West Virginia Medicaid maintains a separate program of Hospice Services for individuals who are residents of a nursing facility. If a member electing hospice care is a resident of a West Virginia Medicaid certified nursing facility, the administrator or designee may contract with a Medicare/Medicaid certified hospice agency to provide hospice services for eligible individuals who qualify medically for both the hospice benefit and Medicaid nursing facility benefits. Medicare certification of a nursing facility is not a requirement of this program. The hospice agency must enroll with the Medicaid agency to be a provider of this benefit in nursing facilities. The hospice agency staff must follow the nursing facilities policies and procedures.
The room and board component provided by the nursing facility shall include the provision of a living space, nutrition, and ancillary services normally provided for residents. Ancillary services may include, but are not limited to, the basic activities of daily living, social and activity programs, and laundry and housekeeping.
The hospice provider is responsible for specialized services covered by Medicare or Medicaid, including but not limited to, medications associated with the terminal illness and assistance with care planning.
The hospice provider becomes an active participant in the interdisciplinary care plan team and the care plan must be immediately updated to reflect these changes. Emotional support for the member and the member’s family is also provided. The hospice must bill Medicare and Medicaid for all covered services, including nursing facility room and board.