Ind. IHCP Hospice Services Provider Reference Module, Section 4, Nursing Facility Residents

For members residing in a nursing facility, the IHCP encourages hospice agencies to provide a copy of the

Medicaid Hospice Election form (State Form 48737 [R2/1-12]) or the Hospice Authorization Notice for

Dually Eligible Medicare/Medicaid Nursing Facility Residents (State Form 51098 [3-03]/OMPP 0014) to

the nursing facility to be included in the hospice member’s nursing facility clinical record. This ensures that

the nursing facility staff knows that the member has the IHCP hospice benefit, whether the member is a

Medicaid-only member or a dually eligible (Medicare and Medicaid) member.

To ensure better communication about reimbursement issues between the hospice and nursing facility, the

hospice must develop coordination procedures with the appropriate staff in the nursing facility billing

department so that the nursing facility biller is aware when the member elects, revokes or is discharged

from hospice care.