Ill. HFS Handbook for Hospice Agencies, Topic K-234.1

Inpatient care must be available for pain control, symptom management, and respite

purposes, and must be provided in a participating facility.

Under 42 CFR Part 418, services for pain control and symptom management can be

provided in:

• A hospital meeting the requirements of Part 418.100 (a) and (e)

• A skilled nursing facility meeting the requirements of Part 418.100 (a) and

(e)

• A hospice that can provide inpatient care directly, in compliance with all

standards under Part 418.100

Contracting for hospital general inpatient services and reimbursing the hospital for

these services is the responsibility of the hospice provider if the hospitalization is for

palliative care related to the terminal illness of the patient. When a hospice patient is

placed in a hospital, the hospital must send the bill to the hospice.

• In the case of an adult age 21 and over, if the hospice determines that the

service was not related to the terminal illness, the hospice must return the bill

to the hospital with a written statement explaining the bill is being denied. The

hospital must attach the denial letter to its UB-04 claim form when it is

submitted to the Department.

• Children through age 20 are allowed to receive curative as well as palliative

care concurrently. If the hospice determines that the child’s service was not

related to the terminal condition, or was related but curative in nature, the

hospice must return the bill to the hospital with a written statement explaining

the bill is being denied. The hospital must attach the denial letter to its UB-04

claim form when it is submitted to the Department.

The Department cannot pay the hospital’s claim without the denial letter from

the hospice.

Under 42 CFR Part 418, services for respite care can be provided in:

• A Medicare-certified hospital meeting the requirements of Part 418.100 (b)

and (e) regarding 24-hour nursing services and patient areas.

• A Medicare-certified skilled nursing facility meeting the requirements of Part

418.100 (b) and (e)

• A Medicare-certified hospice that can provide inpatient care directly, in

compliance with all standards under Part 418.100.

• A Medicare or Medicaid-certified nursing facility that meets the standards

specified in 42 CFR Part 418.110(e).