Ind. IHCP Hospice Services Provider Reference Module, Section 5, Dually Eligible Members in Nursing Facilities

Dually eligible (Medicare and Medicaid) members residing in nursing facilities must elect, revoke or

change providers under both the Medicare and the IHCP programs at the same time. The hospice provider

is required to notify both programs of any changes in the dually eligible member’s hospice care status.

The IHCP requires that the hospice provider submit all the required certifica tion forms as described in

Section 3: Member Eligibility for Hospice Services of this module.

The following paragraphs address different scenarios whereby a dually eligible member residing in a

nursing facility must be enrolled in both programs:

• An IHCP-eligible member already enrolled in the IHCP hospice benefit becomes eligible for

Medicare benefits midway through IHCP hospice care. The hospice member must be enrolled

in the Medicare hospice benefit at the same time of Medicare eligibility. In this situation, a

Change in Status of Medicaid Hospice Patient form must be completed and submitted to the IHCP

PA-UM contractor. This form indicates that the IHCP member is now eligible for Medicare. For

such individuals, before the initiation of hospice care, hospice providers must make adequate

preparation in the event the IHCP hospice member becomes Medicare-eligible.

• A dually eligible member declines Medicare hospice services, elects Medicare skilled nursing

facility (SNF) care, exhausts the 100 days of Medicare nursing facility care, and elects the Medicare

hospice benefit. In this situation, dually eligible members who live in a nursing facility must

complete the required certification forms as described in this section, if Medicare benefits for

nursing facility care have been exhausted. The hospice provider must bill Medicare for the hospice

services and then bill IHCP for 95% of the nursing facility case-mix rate for the nursing facility

room-and-board services.

• A dually eligible member residing in a nursing facility has elected the Medicare hospice benefit and

then becomes eligible for the IHCP. The dually eligible member must also be enrolled in the IHCP

hospice benefit by completing the required certification forms, as described in this document. The

hospice provider must bill Medicare for the hospice services and then bill the IHCP for 95 % of the

nursing facility case-mix rate.