Ind. IHCP Hospice Services Provider Reference Module, Section 1, Hospice Providers’ Contractual Responsibilities as the Professional Manager of a Member’s Hospice Care

Federal regulations at 42 CFR 418.112(b) specify that the hospice provider is the professional manager of

the hospice member’s hospice care. As such, the hospice provider’s responsibilities include coordinating

the plan of care and ensuring that the plan of care is consistent with the hospice ph ilosophy of care.

If the hospice patient requires care from another healthcare professional, outpatient clinic or inpatient clinic

for treatment of the terminal illness or related conditions, it is the responsibility of the hospice to obtain a

contract with the healthcare professional or other healthcare provider for the arranged services. The

contract must contain the minimum criteria stated in 42 CFR 418.100(e) and specify that it is the

responsibility of the hospice to pay the contracted provider for the arranged services. The hospice provider

must also ensure that the contracted provider understands that it is inappropriate for the contracted provider

to bill Medicare or the IHCP directly for the contracted services, because the hospice provider reimburses

the contracted provider directly.

The hospice provider must ensure that noncore services are provided directly by the hospice or under

arrangements made by the hospice as specified in 42 CFR 418.100.