CO · guidance
CO HCPF Hospice Billing Manual — Hospice Benefits
HospiceBenefits
ThemembermayreceiveHealthFirstColoradoHospiceBenefit(MHB)servicesina:
Privateresidence
Residentialcarefacility(AlternativeCare)
Licensedhospicefacility
IntermediateCareFacilityforIndividualswithIntellectualDisability(ICF-IDD)
SkilledNursingFacility(SNF)
NursingFacility(NF)
EffectiveMay3,2024,placeofservice03isanallowedplaceofserviceforallfee-for-servicebenefits.Inorderforcommunityproviderstobillfee-for-servicetochildreninaschoolsetting,theprovidermustfollowschooldistrictpolicy.PleasereferencetheCommunityProvidersinaSchoolSettingPolicymemo.
HealthFirstColoradoHospiceBenefitmembersresidinginanursingfacilitymustmeethospicelevelofcareandfinancialHealthFirstColoradoeligibilitycriteria.
HospiceSNF/NFroomandboardreimbursementismadetothehospiceproviderforeachhomecarelevelday(routineorcontinuouscare).
ThemembermustchooseMHBservices.
Themember'sattendingphysicianmustcertifythatthememberisterminal.
Boththememberandtheattendingphysicianmustagreetotheplanofcaredevelopedbythehospiceprovider.
AparticipatingMHBprovidermustprovideallMHBservices.
Hospiceservicesareco-paymentexempt.
PhysicianservicesarenotacoveredMHB,theyarebilledbythephysicianasaregularphysicianservice.
TheSNF/NFprovidesthehospicewiththeroomandboardperdiemamountforhospicemembersresidinginanSNF/NF.ThehospicebillsroomandboardonbehalfofthemembertoHealthFirstColoradowhichreimburses95%oftheperdiemamount,andthehospicepassestheroomandboardpaymentthroughtotheSNF/NF.
ThepatientliabilityamountmayapplywhenahospicememberresidesinanNF.ThisispaymentmadebythememberforNFcare,afterthepersonalneedsallowanceandotherapprovedexpensesaredeductedfrommemberincome.ThepersonalneedsallowanceandotherapproveddeductionsaredeterminedbyCountyIncomeMaintenanceTechnicians.Thepatientliabilityamountmustbeappliedtothemember'scare.
Whenreportingthepatientliabilityamountfortheentiremonth,regardlessofthenumberofdaysinthatmonth,applythetotalpatientliability.
Example:Billthefull$100.00(PerDiemRate)amountTheprocessingsystemautomaticallydeducts5%-$100X.95=$95.00$95.00X31=$2,945.00$2,945.00-$500.00=$2,445.00(NFRandB)$2,445.00+$3,500.00(routinehomecareamount)=$5,945.00TotalReimbursement.
UsetheperdiemcalculationtocalculatethecorrectamountwhenreportingthepatientliabilityamountsforlessthanonefullmonthofNFcare.Theperdiemcalculationisthenumberofdaysinthefacility,excludingthedateofdischarge,timesthefacilityperdiemrate.
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CalculatetheHealthFirstColoradoamountbymultiplyingthenumberofdaysforpaymenttimestheperdiemamount.
IftheHealthFirstColoradoamountexceedsthepatientliabilityamount,thepartialmonth'spatientliabilityamountremainsthesameastheregularpatientliabilityamount.
IfthepatientliabilityismorethantheHealthFirstColoradoamount,thepartialmonth'spatientliabilityisthesameastheHealthFirstColoradoamount.Theexcessofthepatientliabilityoverthepartialmonth'spatientliabilitybelongstotheresidentand,ifithasalreadybeenpaidtothefacility,shallberefundedtotheresident.ItistheSNF's/NF'sresponsibilitytocollectpatientliability.Thehospicedoesnothavetocollectpatientliability.ThehospicemaychoosetocollectthisamountandpaytheSNF/NF.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
0d8dde5cdf6ebd528b5a9d16fe4d9a03daead3baaa55aee585b17c413dfa2184
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