1. (1) The medicaid agency pays hospitals that provide inpatient care to clients in the hospice program for medical conditions not related to their terminal illness according to chapter 182-550 WAC, Hospital services.

2. (2) The medicaid agency pays providers who are attending physicians and not employed by the hospice agency the usual amount through the physician-related services fee schedule:

   1. (a) For direct physician care services provided to a hospice client;
   2. (b) When the provided services are not related to the terminal illness; and
   3. (c) When the client's providers, including the hospice agency, coordinate the health care provided.

3. (3) The department of social and health services (DSHS) home and community living administration pays for services provided to a client eligible under the community options program entry system (COPES) directly to the COPES provider.

   1. (a) The client's monthly participation amount for services provided under COPES, if there is one, is paid separately to the COPES provider; and
   2. (b) Hospice agencies must bill the medicaid agency's hospice program directly for hospice services, not the COPES program.

[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 25-16-015, s 182-551-1520, filed 7/25/25, effective 9/1/25. Statutory Authority: RCW 41.05.021, Section 2302 of the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), and Section 1814 (a)(7) of the Social Security Act. WSR 12-09-079, § 182-551-1520, filed 4/17/12, effective 5/18/12. WSR 11-14-075, recodified as § 182-551-1520, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.520. WSR 05-18-033, § 388-551-1520, filed 8/30/05, effective 10/1/05. Statutory Authority: RCW 74.09.520, 74.08.090, 42 C.F.R. 418.22 and 418.24. WSR 99-09-007, § 388-551-1520, filed 4/9/99, effective 5/10/99.]