Ntinued NOTIFICATION OF MEDICAID HOSPICE BENEFIT ELECTION F-1008 (08/2019) Page 2 of 2 SECTION III — COMPLETE FOR MEMBERS ENTERING A NURSING HOME AFTER HOSPICE ADMISSION The hospice and nursing home named below are in agreement that the hospice shall provide hospice services, while the nursing home shall provide room and board services as defined under COBRA, P.L. 99-272. “Room and board” includes the performance of personal care services, including assistance in the activities of dail.
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How to fill out the WI DHS F-1008 online
Filling out the WI DHS F-1008 form, also known as the Notification of Hospice Benefit Election, is a key step in accessing hospice services through Wisconsin Medicaid. This guide provides a clear, step-by-step approach to help you complete the form accurately and efficiently.
Follow the steps to complete the WI DHS F-1008 online.
- Click the ‘Get Form’ button to obtain the form and open it in the editor.
- Section I needs to be filled out for all hospice members. Start by entering the member’s full name (First, Middle Initial, Last) and member ID.
- Record the date when the Member Election of Hospice Benefit form, F-01009, was signed.
- Provide the name of the hospice along with its National Provider Identifier (NPI).
- Enter the name of the attending physician and their National Provider Identifier (NPI).
- Indicate whether the attending physician is employed by the hospice by checking 'Yes' or 'No'.
- If the member is residing in a nursing home at the time of hospice election, complete Section II, providing the name and NPI of the nursing home; also indicate the level of care needed.
- If the member is entering a nursing home after hospice admission, complete Section III, including the date of admission to the nursing home.
- For revoking hospice benefits, complete Section IV by entering the member ID, hospice NPI, the date the revocation form was signed, and the name and NPI of the attending physician.
- After filling out the form, ensure that all information is accurate, then save any changes made. You can choose to download, print, or share the completed form as needed.
Complete your documents online to ensure timely processing and access to essential services.
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