Question: What State Agency Is Responsible for Medicaid Hospice?
Disclaimer:The answers provided in this document are the result of the Texas and New Mexico Hospice Organization’s research and analysis. If you have specific questions on rules and interpretation, contact the Texas Department of Aging and Disability Services’ Contracting Section at the State Offices.
Question: What state agency is responsible for Medicaid Hospice?
Answer: The Contract Accountability and Oversight Section under the Access and Intake Division at the Texas Department of Aging and Disability Services (DADS) is responsible for the Medicaid Hospice Program.
Question: If I want to provide hospice services to someone on Medicaid what do I do?
Answer: Providers will need to become a Medicaid hospice provider by entering into a contract with DADS.
Question: Do I have to be licensed and certified to become a Medicaid hospice provider?
Answer: Yes. §49.205 License, Certification, Accreditation and Other Requirements require that a hospice provider, interested in becoming a Medicaid hospice provider, be licensed and certified by the Centers for Medicare and Medicaid (CMS).
Question: If I am interested in contracting with DADS will I receive a standard contract?
Answer: No. Rules state that all entities interested in contracting to provide Medicaid services will submit an application for a provisional contract. 40 TAC §49.202 Provisional Contract states: “To obtain a contract for a service or program for which a person does not have a contract, or a contract in a service or catchment area in which the person does not have a contract, the person must apply for a provisional contract in accordance with §49.203 of this subchapter (relating to Provisional Contract Application Process) and §49.204 of this subchapter (relating to Additional Provisional Contract Application Requirements).”
Question: What is a provisional contract?
Answer: A provisional contract is a time limited initial contract. At the end of the term of a provisional contract, a contractor may be considered for a standard contract with no expiration date.
Question: When will I get a standard contract?
Answer: A standard contract is effective the day after the provisional contract expires. §49.209 (c) states that a hospice that has a provisional contract qualifies for a standard contract if the hospice provider is licensed and certified.
Question: Do existing Medicaid contract holders have to re-apply for a new contract and obtain a provisional contract?
Answer: No. §49.202 Provisional Contract states that provisional contracts apply to those who do NOT have a contract with DADS. This would pertain to entities that are getting a contract for the first time or to those entities that may have had a contract but lost their Medicaid contract for some reason, such as the contracted provider did not provide any Medicaid services in a period of 12 consecutive months as outlined under §49.534 (a) (2)(A).
Question: How long does the contracting process take?
Answer: Contracting staff begin reviewing the application within three weeks of receipt of the application. The overall process generally takes three months or so.During that time period staff may send a letter, requesting additional information and/or corrections. There are no contracting rules on the timeframes for processing an application.
Question: Where is the contracting website?
Answer: The contracting website is at:
Question: What rules do I have to follow?
Answer: There are two sets of Medicaid rules you will follow.
- 40 Texas Administrative Code (TAC) Chapter 49 Contracting to Provide Community Services:
- 40 TAC Chapter 30 Medicaid Hospice Program:
For a complete list of all the rules applicable to the hospice provider, go to:
Question: I do not have a Medicaid contract. Can I provide services to someone who is dual eligible in a nursing facility or ICF/IID because Medicare is paying for Medicare hospice?
Answer: No. Federal and state rules require people who are dual eligible to elect the Medicare and Medicaid hospice program simultaneously. Medicaid is paying for the care (room and board) at the NF or ICF/IID so you will need to have Medicaid contract with DADS. For additional information on what is required to provide services in NF see Information Letter #13-39 Clarification for Medicaid Hospice Providers Enrolling Individuals Residing in a Facility into the Texas Medicaid Hospice Program and Information Letter No. 09-32 Clarification of the Provision and Billing of Hospice Services for Medicaid Nursing Facility Residents
Question: Who pays for Medicaid hospice services?
Answer: Once you have signed your provisional or standard contract, you are ready to provide services to dual eligible and Medicaid hospice recipients. The Texas Medicaid and Healthcare Partnership (TMHP) is responsible for the claims processing for DADS. Tosign up as a provider and review their requirements, go to: and select Provider at the top of the page.
Question: Is there any new provider training?
Answer: Yes. TMHP provides training to hospice providers on the claims processing requirements. The training is online or in the classroom. Go to: and select Provider Education.
Question: Where do I access the Medicaid hospice forms?
Answer: You can access the hospice forms at: TMHP has the electronic forms for billing and payment.
Question: Is there any training on forms?
Answer: Yes. TMHP provides training on the completion of the Texas Medicaid Hospice Program Individual Election/Cancellation/Discharge Form 3071 and the Texas Medicaid Hospice Program Physician Certification for Terminal Illness Form 3074. The training is online or in the classroom.Go to: and select Provider Education.
Question: What kind of audits does DADS do when I become a Medicaid hospice provider?
Answer: DADS does not do contract monitoring as they do with other Medicaid contracts. The Utilization Review (UR) Section under Access and Intake conducts UR reviews of continuous home care, physician narratives, hospice eligibility and length of stay.
Question: Where is the Medicaid Hospice Program Website?
Answer: The Medicaid Hospice Program website is at:
Question: What is the best way to stay up to date on the Medicaid hospice information that comes from DADS?
Answer: The best way to stay “up to date” on hospice information is to sign up under govdocs and identify all the areas you would like to be notified about. Go to: and select Email Updates.
Question: What areas do I contact for questions on Medicaid hospice?
Answer: Areas that answer Medicaid hospice questions are:
- Contract Section (512) 438-2080
- Medicaid Hospice Policy Email:
- DADS Provider Claims Services Hotline: 438-2200
- Email for billing and form issues: hhsportal.hhs.state.tx.us/wps/portal. First time users will need to set up an account.
- TMHP: 1-800-925-9126.
P.O. Box 1525, Austin, Texas 78767 1108 Lavaca, Ste. 727, Austin, TX 78701
1-800-580-9270 (512) 454-1247
FAX (512) 454-1248