Ind. IHCP Hospice Services Provider Reference Module, Section 5, Clarification Regarding When the IHCP Can Mirror a Hospice Agency’s Benefit Periods

The IHCP has been asked two questions regarding when the IHCP mirrors a hospice agency’s benefit periods.

To provide written clarification, this section provides a formal response to two case-specific scenarios.

Note: The information in these examples is specific to the FFS hospice benefit. For

managed care hospice members, specific procedures may vary; contact the member’s

managed care entity for details.

Example 1: Medicare Beneficiary Residing at Home Is Admitted to a

Nursing Facility

Scenario

A patient is a Medicare beneficiary who resides at home. The patient elects the Medicare hospice benefit

on Feb. 10, 2022. The patient is admitted to a nursing facility Feb. 28, 2022. When IHCP eligibility is

established and the Preadmission Screening and Resident Review (PASRR) process is completed, the

hospice member may then choose to elect the IHCP hospice benefit. Appropriate forms are issued from the

state’s web-based PASRR system.

Question

If the member elects the IHCP hospice benefit, can the IHCP FFS PA-UM contractor process the hospice

authorization such that the IHCP hospice benefit mirrors the Medicare hospice benefit periods by an

agency?

FSSA Response

Yes. The IHCP hospice benefit periods mirror the Medicare hospice benefit periods.

• The IHCP processes all hospice authorization requests using the Julian calendar. Hospice care dates

cannot overlap from one hospice benefit period to the next hospice benefit period.

• To facilitate the process for the IHCP PA-UM contractor, the hospice provider must include a cover

letter with a request that the hospice analyst have the IHCP hospice benefit periods mirror the

Medicare hospice benefit periods. The hospice agency must include the following information in the

cover letter:

➢ The election or reelection date of the Medicare hospice benefit

➢ The date the individual became IHCP-eligible

IHCP hospice benefit periods cannot be authorized before the date of IHCP eligibility.

Therefore, in this example, the hospice analyst must enter Feb. 28, 2021, as the start date of the

IHCP hospice benefit.

The following attachments need to be submitted with the cover letter:

➢ A copy of the agency’s Medicare hospice election form to validate the date the individual

elected hospice (Providers are asked to clearly indicate the member’s name, date of birth and

Medicaid Member ID on the form)

➢ The Hospice Authorization Notice for Dually Eligible Medicare/Medicaid Nursing Facility

Residents form (State Form 51098 [3-03]/OMPP 0014) with Sections A and B completed to

reflect IHCP-required information

➢ The Change in Status of Medicaid Hospice Patient form that explains the date the individual left

home and was admitted to the nursing facility

• To have the hospice authorization end at the same time as the Medicare hospice benefit period, the

IHCP PA-UM hospice analyst must perform the following review using the Julian calendar method:

➢ Use the Medicare election date of Feb. 10, 2021, to determine the end date of the Medicare

hospice benefit period.

➢ The initial Medicare election date of Feb. 10, 2021, is Julian day 41.

➢ Julian day 41 (Feb. 10, 2021, or hospice election date) plus 90 days in first hospice benefit

period equals Julian day 130 or May 10, 2021, which is the end date of first Medicare hospice

benefit period.

➢ IHCP hospice authorization is then granted for an open-ended segment.

Example 2: Hospice Patient With Private Insurance (Such as Blue Cross

and Blue Shield) Becomes IHCP-Eligible During a Hospice Benefit Period

Scenario

A hospice patient residing at home elects hospice Jan. 31, 2021. The patient has private insurance and is

not a Medicare beneficiary. The patient becomes IHCP-eligible Feb. 10, 2021, and elects the IHCP

hospice benefit on the same date by signing the Medicaid Hospice Election form.

Question

Can the IHCP FFS PA-UM contractor process the hospice authorization such that the IHCP hospice benefit

period mirrors the start date under private insurance so that the hospice agency does not have to track two

sets of hospice benefit periods?

FSSA Response

No. Although the IHCP works with hospice agencies to authorize IHCP hospice benefit periods that mirror

the Medicare hospice benefit periods, a newly enrolled Medicaid-only hospice member with existing

hospice coverage through private insurance cannot be tracked in the same manner because the member’s

enrollment date in the IHCP hospice benefit would not be the same date as enrollment in the hospice

agency’s hospice program. In this example, the first IHCP hospice benefit period is authorized from

Feb. 10, 2021, the date of IHCP hospice election, through May 10, 2021.