BOARD MEMBERS Jon M. Bradley Chair, Dallas Jerry Kane Vice Chair, Corpus Christi Abigail Rios Barrera, M.D. San Antonio John A. Cuellar Dallas Manson B. Johnson Houston Terry Durkin Wilkinson Midland
COMMISSIONER James R. Hine May 29, 2002

To: Hospice Providers

Re: Provider Letter #02-20 -- Medicaid /Medicare Physician Certification of Terminal Illness Form 3074

The Texas Department of Human Services (DHS) implemented the new Medicaid /Medicare Physician Certification of Terminal Illness Form 3074 and instructions on May 1, 2002. Since the implementation the department has noted a need for clarification in the area of the certification and re-certification dates (box #9). The date entered in box #9 is the current certification or re-certification date. The re-certification form must be signed by the physician no earlier than 30 workdays prior to the re-certification date or anytime during the six month re-certification period.

The department apologizes for any inconvenience this may have caused you. If you have any questions, please contact Maxcine Tomlinson, Medicaid Hospice Program Manager, at (512) 438-3169.

Sincerely,

- Original Signature on File -

Marc Gold
Director
Long Term Care Policy

MG:mt