Ind. IHCP Hospice Services Provider Reference Module, Section 3, Members Residing in a Nursing Facility

For the IHCP to reimburse nursing facility care for a hospice member (including nursing facility room-and-board as well as applicable add-on payments, as described in the Payment for Nursing Facility Residents

section), the nursing facility, Area Agency on Aging (AAA) or hospital must complete the Preadmission

Screening and Resident Review (PASRR) process for the hospice member. The local AAAs serve as the

primary point of entry for at-home residents seeking placement in a Medicaid-certified facility. All IHCP and

non-IHCP applicants to IHCP-certified nursing facilities are entered in the state’s PASRR web-based system,

and a Level I screen is completed to initiate the PASRR process. For individuals seeking Medicaid coverage

of their nursing facility stay or any individual triggering a Level II evaluation, a level-of-care (LOC)

assessment is also completed. For more information about the process, see the Long-Term Care module and

the Indiana PASRR provider manual (available from the Indiana PASRR Tools and Resources page at

maximusclinicalservices.com).

When this process is completed, the member’s record in Core Medicaid Management Information System

(CoreMMIS) is updated with the nursing facility LOC. IHCP prior authorization and utilization management

(PA-UM) contractors cannot process any hospice authorizations for a nursing facility resident until that

member has a nursing facility LOC assigned in CoreMMIS. If the hospice provider submits the request for

hospice, the request is placed in a pending status until CoreMMIS reflects the nursing facility LOC. The

hospice provider may also choose to hold all paperwork until the nursing facility advises the hospice that the

appropriate authorization has been obtained from the PASRR process.

The Division of Aging recommends the following procedures to determine whether a hospice member has

nursing facility LOC in CoreMMIS:

• Develop coordination and notification procedures between the appropriate nursing facility staff and

hospice staff about the approval of the PASRR and LOC screening for hospice members.

• Address the coordination and notification responsibilities between nursing facility and hospice staff

in the hospice contracts with nursing facilities.

• Check the phone-based virtual assistant (GABBY) or the IHCP Portal to determine whether there is

nursing facility LOC for private-home hospice members recently admitted to the nursing facility.

For Traditional Medicaid (FFS) members, hospice claims for room-and-board services pay only if

CoreMMIS reflects both hospice LOC and nursing facility LOC for the dates of service billed at the time

the claim is processed by the IHCP. If the remittance advice (RA) reflects explanation of benefits (EOB)

code 2026 – Member not eligible for the level of care for the dates of service and revenue codes billed, the

provider may contact Customer Assistance toll-free at 800-457-4584 to assist with the following:

• Verify that the hospice member, using the Member ID provided, has a nursing facility LOC for the

dates of service.

• Determine when the nursing facility LOC was entered into CoreMMIS. For example, if the hospice

claim was processed March 9, 2024, but the nursing facility LOC was not in CoreMMIS until

March 10, 2024, the claim denied appropriately.

If the hospice provider cannot resolve a hospice or nursing facility LOC problem, the provider should

contact the Long Term Care Help Desk at 317-488-5094.

Obtaining IHCP Nursing Facility Level of Care for Individuals Who Die

Shortly After Admission to the Nursing Facility

When an individual dies shortly after the nursing facility placement, before the PASRR process is completed,

the nursing facility is still able to complete the LOC assessment through the Indiana state’s web-based PASRR

system. The nursing facility must complete this process and advise the hospice provider so that the hospice

provider can bill the IHCP for hospice room-and-board and bed-hold services. If this process is not completed,

there is no mechanism for the IHCP to reimburse for room-and-board services billed under hospice revenue

code 659. Because hospice revenue code 659 pays only room and board, the hospice provider’s reimbursement

is not affected, as Medicare reimburses for the hospice services. Hospice revenue codes 65 0 and 658 include

reimbursement for the hospice per diem plus the room-and-board add-on for Medicaid-only members residing

in nursing facility. When the nursing facility does not complete the process, the hospice provider is precluded

from billing the IHCP for the hospice per diem under hospice revenue codes 650 and 658.

Therefore, the IHCP has developed the following process to ensure payment of the hospice per diem

through a non-claim-specific check:

Note: The following process applies to Traditional Medicaid (FFS) members. If the member is

enrolled in managed care, the provider should check with the member’s MCE, as their

processes for this circumstance may vary.

1. The hospice should fax a cover letter to the FFS PA-UM hospice analyst explaining that the

contracted nursing facility does not intend to complete the PASRR process due to the member dying

shortly after placement. The cover letter should include the following information:

➢ Name and provider number of the nursing facility

➢ Name and telephone number of a contact person at the hospice agency

The letter should be addressed to the attention of the Hospice Analyst and faxed to the FFS PA-UM

contractor; see the IHCP Quick Reference Guide for contact information.

2. With the letter, the hospice provider should also fax a properly completed hospice claim reflecting

the dates of service for which the hospice requires reimbursement for the hospice per diem.

Note: The 180-day claim filing limit does apply to this scenario, so it is imperative that the

hospice biller check eligibility on a regular basis and communicate with the nursing

facility regularly about the PASRR approval process for each hospice member.