Ind. IHCP Hospice Services Provider Reference Module, Section 1, Medicaid Hospice in Conjunction With Other Funding Sources

Hospice providers should remember that the Medicare and Medicaid hospice programs are primarily for

the treatment of terminal illness and related conditions. Home- and Community-Based Services (HCBS)

waiver programs and Community and Home Options to Institutional Care for the Elderly and Disabled

(CHOICE) may supplement Medicare or Medicaid hospice. From a funding-stream perspective, the IHCP

has always noted that there is a hierarchy of funding streams, in the following order:

1. Private pay/Medicare (Medicare hospice)

2. Medicaid (Medicaid hospice)

3. HCBS waiver programs

4. CHOICE

Federal Medicare regulations require hospices to list on the plan of care the frequency and scope of all

hospice-covered services needed to treat the terminal condition. In an effort to ensure better coordination

among the personal care services, the IHCP requires hospice providers to submit documentation of the

following additional items:

• Other caregiving services received by the member, including but not limited to services provided by

HCBS waiver programs or CHOICE

➢ This list must be included in the hospice authorization request.

• Frequency and scope of the visits planned by each discipline to treat the member’s terminal illness

and related conditions

➢ This list must be included in the hospice plan of care.

• Frequency and scope of overlapping services provided by the HCBS waiver program or CHOICE

for the member’s nonterminal conditions

➢ This list must be included in the hospice plan of care.

See Section 5: Hospice Authorization for more information about documentation requirements and

submission procedures.

The IHCP requests this additional information to ensure coordination among the different hospice provider

case managers. The IHCP fee-for-service (FFS) prior authorization and utilization management (PA-UM)

contractor can approve the medical necessity only with regard to the hospice care. The HCBS waiver case

managers and CHOICE case managers must adjust their respective care plans. The IHCP or the FSSA has

the discretion to review care plans from various programs to ensure that there is no duplication of service

across program lines when serving a member.