Ga. Medicaid Part II Policies & Procedures for Hospice Services § 1010

The Division will reimburse the hospice an additional per diem rate for routine home care and

continuous home care days of service that are furnished to an individual living in a nursing facility.

This rate is designed to cover “room and board” which includes performance of personal care

services, including assistance in the activities of daily living, administration of medication,

maintaining the cleanliness of the member’s environment, and supervision and assistance in the use

of durable medical equipment and prescribed therapies.

These additional payments are not subject to the cap on overall reimbursement.

Effective with services rendered on and after April 1, 1990, the rate of reimbursement is 95% of the

per diem that would have been paid to the nursing facility for that individual in that facility under the

State plan. This rate is in addition to the routine home rate or the continuous home care rate. The

additional room and board rate must be billed on the UB04 claim form using revenue code 659.

Hospice agencies should not admit members into a nursing facility that have been issued a denial of

payment for nursing facility admissions (DPNA) letter from the Department of Community Health

(DCH). Claims submitted for room and board for those members admitted to the nursing facility

after the date of the DPNA payment will be denied.

This does not apply to members that were residents in a nursing facility prior to the DPNA who elect

hospice.

1010.1. Residential Hospice Facility Residents

The Division will not reimburse Room and Board for patients residing in Residential

Hospice Facilities.

NOTE: General Inpatient Care and Nursing Home Room and Board cannot be

reimbursed for the same member on the same covered days of service.

Nursing Home Room and Board cannot be reimbursed for the member on the day of

discharge or death.