Ill. HFS Handbook for Hospice Agencies, Topic K-250.7

Section 1905 (o)(3) of the Social Security Act mandates that the Department provide

payment to the hospice agency for nursing home room and board charges for long

term care (LTC) facility residents receiving hospice care. The LTC facility cannot bill

hospice patients’ nursing home room and board charges directly to the Department.

The hospice is responsible for paying the facility.

Contracts between hospice providers and long term care facilities should specify the

responsibilities of the hospice provider for reimbursing the facility in a timely manner

for the room and board charges. Disputes regarding payment of the room and board

charges must be resolved between the long term care facility and the hospice

provider.

For long term care patients, including residents of a Supportive Living Facility (SLF),

who are eligible for Medicare Part A, the hospice must bill Medicare for the hospice

care and physician services. However, the hospice must still send in a notification of

election to the Department identifying the patient’s actual hospice election date, so

that information may be put in Department files. The Department does not cover the

room and board of patients residing in a SLF.

Room and board services include the performance of personal care services,

assistance in activities of daily living, socializing activities, administration of

medication, maintaining the cleanliness of a resident’s room and supervising and

assisting in the use of durable medical equipment and prescribed therapies. Also

included are medical supplies and over-the-counter medications.

The Department reimburses the hospice provider a rate equal to ninety-five percent

(95%) of the facility’s Department calculated per diem rate for basic care minus any

patient income. This patient income is known as patient credit, and is determined by

the patient’s DHS local office (Family Community Resource Center, or FCRC).

If a patient resides in more than one LTC facility in a billing period, the hospice must

split its claim and submit bills according to dates the patient is in each facility. If the

patient is discharged and readmitted to the same facility, separate claims must also

be submitted. This will ensure correct reimbursements for the nursing home room

and board payment.

No reimbursement will be authorized for a bed hold fee for a LTC hospice patient.