Idaho Medicaid Provider Handbook, Home Health and Hospice Services § 4.4.2

Idaho Medicaid hospice billing for routine home care uses Revenue Code 0651. Authorizations

will be issued by the Medical Care Unit and manually priced:

•

For the Day 1-60 higher payment rate.

•

For the Day 61-240 reduced rate.

•

For subsequent reduced rate periods when applicable.

•

For the Service Intensity Add-on (SIA) in the last seven days of life. The provider will

need to submit the dates and total increments for which the SIA applies.

The Hospice Notification Form must be faxed to the Medical Care Unit to request

authorizations as described above. Participants with Medicare primary will not require

authorizations related to Revenue Code 0651; Medicare will pay those claims according to

Payment Reform.

(a)

References: Routine Home Care

(i) Federal Regulations

“Payment Procedures for Hospice Care.” 42 CFR §418.302 (2015), Government Printing

Office, https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-

G/section-418.302.

(ii)

Idaho Medicaid Publications

Hospice Rates, Information Release MA15-08 (1/1/2016). Division of Medicaid, Department

of Health and Welfare, State of Idaho.

(iii)

State Regulations

Medical Assistance Program – Services to be Provided, Idaho Code 56-255(3)(g) (2018).

Idaho State Legislature,

https://legislature.idaho.gov/statutesrules/idstat/Title56/T56CH2/SECT56-255.

“Medical Necessity (Medically Necessary).” IDAPA 16.03.26, “Medicaid Plan Benefits,” Sec.

006.15. Department of Administration, State of Idaho,

https://adminrules.idaho.gov/rules/current/16/160326.pdf.