Ind. IHCP Hospice Services Provider Reference Module, Section 3, Dually Eligible (Medicare and Medicaid) Members

Individuals eligible for Medicare Part A and Medicaid (dually eligible members) receive hospice services

through the Medicare program. For dually eligible members with Traditional Medicaid or PathWays

coverage, the IHCP does reimburse for certain services not covered under the Medicare hospice benefit,

such as copays for respite care and deductibles for medications. Accordingly, the IHCP requires the

following:

• Dually eligible members residing in nursing facilities elect, revoke and change hospice providers,

and change addresses, under both the Medicaid and Medicare programs at the same time.

➢ The IHCP does not require dually eligible hospice members residing in private homes to enroll

in the Medicaid hospice benefit, because Medicare is paying for the hospice services. This same

standard applies to dually eligible members residing in any residential setting other than a

nursing facility, including intermediate care facilities for individuals with intellectual disabilities

(ICFs/IID), licensed residential care facilities enrolled as Medicaid assisted living providers and

Medicaid adult family care providers.

• State Operations Manual, Section 2082, and federal regulations under OBRA-89 require the hospice

provider to submit the necessary certification paperwork to the state Medicaid agency. Because

the dually eligible member elects, revokes and changes a provider under both the Medicare and

Medicaid programs, it is the hospice provider’s responsibility to notify both Medicare and the IHCP

about any change in the hospice member’s hospice care status.

➢ Failure to submit the necessary certification forms constitutes noncompliance with state and

federal statute. See Section 5: Hospice Authorization in this module for more information about

the required certification forms and the different situations in which a dually eligible member is

enrolled in both programs.

• The hospice provider and the nursing facility must follow certain procedures to ensure compliance

with 405 IAC 1-16-4. Failure to follow these procedures results in recoupment by the IHCP. See

Section 6: Billing and Reimbursement in this module for more information about the procedures that

the nursing facility and the hospice provider must follow.

• Additionally, hospice providers are required to coordinate regularly with nursing facility providers.

To ensure that the IHCP member’s enrollment in the IHCP hospice benefit is clear to both hospice

and nursing facility staffs, the hospice provider must furnish the nursing facility staff with the

member’s Medicaid hospice forms. The hospice must develop coordination procedures with the

nursing facility billing department to inform the nursing facility of hospice care status.

Note: Among dually eligible members, only those with comprehensive Medicaid benefits

(under either “Full Medicaid” or “Package A – Standard Plan”) are eligible for

IHCP hospice benefits. Members with only Qualified Medicare Beneficiary

(QMB-Only), only Specified Low Income Medicare Beneficiary (SLMB-Only),

Qualified Individual (QI) or Qualified Disabled Working Individual

(QDWI)coverage, as well as those with limited Medicaid coverage under the

Family Planning Eligibility Program, are not eligible for IHCP hospice benefits.

Additionally, dually eligible members with a liability must meet liability requirements

each month before the full Medicaid coverage goes into effect; until then, they are

considered QMB-Only or SLMB-Only. For more information, see the Member

Eligibility and Benefit Coverage module.