OHP 525 DHSOHA Hospice Notification for Nursing Facility Residents 2025

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The form is used to notify Aging and People with Disabilities (APD) & Area Agency on Aging (AAA) when an Oregon Medicaid nursing facility resident elects hospice care or experiences changes in their status.
The form must be completed and submitted within two business days of the hospice election.
If you receive this document in error, you should notify the sender immediately and destroy the message.
You need to provide details such as Medicaid provider number, contact information, resident's Medicaid ID, date of birth, nursing facility name, and any transfer information if applicable.
Yes, you can use this form to submit updates when a resident’s status changes.
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Oregons Medicaid program covers hospice services. The name of the Medicaid program in Oregon is the Oregon Health Plan, or OHP. Hospice staff work closely with patients, their loved ones and nursing facility staff to give the best care possible.
The purpose of this addendum is to notify the requesting Medicare beneficiary (or beneficiary representative), in writing, of those conditions, items, services, and drugs not covered by the hospice because the hospice has determined they are unrelated to your terminal illness and related conditions.

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