Ill. HFS Handbook for Hospice Agencies, Topic K-250

The Centers for Medicare and Medicaid Services (CMS) establishes payment

amounts for the following specific categories of covered hospice care: routine home

care, continuous home care, service intensity add-on, inpatient respite care and

general inpatient care. The Department establishes payment amounts for physician

services and nursing home room and board.

Medicaid hospice payment rates are calculated based on the annual hospice rates

established under Medicare. These rates are authorized by Section 1814(i)(1)(C)(ii)

of the Social Security Act, which also provides for an annual increase in payment

rates for hospice care services. Hospice physician services are not increased under

this provision.

CMS determines base rates. Actual payment amounts for routine home care,

continuous home care and service intensity add-on are based upon the geographic

location (Core-Based Statistical Area) where the service is furnished. Hospice

providers must use the appropriate Value Code and CBSA on their claims to identify

the location where the routine home care or continuous home care services were

provided. Each CBSA is assigned a wage index that reflects local geographical

differences in wage levels. Payment is determined when the wage index is added to

the payment calculation for each service. The listing of CBSAs and corresponding

wage indices is announced annually in the Federal Register. The Department posts

the CBSAs pertinent to Illinois, with current reimbursement information, on the

website.

Rates for general inpatient care and inpatient respite care are based upon the CBSA

where the inpatient facility is located. Hospice providers must use the appropriate

Value Code and CBSA on their claims to identify the location of the inpatient facility.

Payment is made for only one of the following categories of hospice care: routine

home care, continuous home care, general inpatient care or inpatient respite care on

a particular day. A service intensity add-on payment may be billed with routine home

care in the last seven days of life if certain criteria are met as defined in Topic

K-250.6.