Ind. IHCP Hospice Services Provider Reference Module, Section 5, Hospice Coverage and Authorization for Managed Care Members

Hospice providers must check IHCP eligibility to determine whether a member is enrolled in managed care.

Hospice coverage and authorization procedures for managed care members var y by program enrollment:

• If the member is enrolled in Hoosier Healthwise, the hospice provider must immediately fax the

Medicaid Hospice Election form to the fee-for-service (FFS) PA-UM contractor, as described in the

Hospice Services for Hoosier Healthwise Members section, to initiate the member’s disenrollment

from managed care. Hospice providers that fail to follow this procedure will not receive payment for

the dates of service that the IHCP member was still enrolled in managed care.

• If the member is enrolled in HIP, Hoosier Care Connect or PathWays, hospice authorization and

claim billing must be directed to the member’s managed care entity (MCE) – see the IHCP Quick

Reference Guide for contact information. HIP, Hoosier Care Connect and PathWays hospice

members will remain enrolled with their MCE for the duration of the hospice period, regardless of

whether they receive in-home hospice care or institutional hospice care. In addition to being

enrolled as a hospice provider in the IHCP and meeting all requirements described in the Medicare

Conditions of Participation for Hospice Care section, the hospice must also ensure that it is enrolled

within the member’s MCE network as a HIP, Hoosier Care Connect or PathWays provider. The

hospice provider is responsible for coordinating all hospice services with the member’s MCE,

including obtaining prior authorization and ensuring that the member has a nursing facility LOC, if

the member will receive hospice services in a nursing facility.

Note: Program of All-Inclusive Care for the Elderly (PACE) members are encouraged to

discuss end-of-life care with their PACE care team and may request end-of-life

services through their PACE program, if available.

If a PACE member elects IHCP hospice benefits, the member must be disenrolled

from PACE and enrolled in Traditional Medicaid. PACE members must adhere to

the PACE program’s voluntary disenrollment process, and the PACE provider is

responsible for coordinating services with new providers, including the hospice

provider, to ensure a smooth transition. All PACE disenrollments take effect at the

end of the last day of the month in which disenrollment is elected. Medicaid hospice

and other IHCP services can begin on the first day of the following month.

For HIP, Hoosier Care Connect and PathWays hospice members that require inpatient care, hospice

provider responsibilities depend on whether the stay is related to the terminal illness, as follows:

• For inpatient stays related to the terminal illness, at the general inpatient hospice level of service

or the inpatient respite hospice level of service, the hospice provider is responsible for the

following:

➢ Obtaining contracts with all IHCP providers for arranged services

➢ Reimbursing the facility according to the contract between the hospice provider and the facility

where the member receives care (Note: The contract between the hospice provider and the

facility covers all costs related to the terminal illness.)

➢ Submitting claims directly to the MCE for reimbursement. (Note: The hospice provider will be

paid at the rate appropriate to the level of service provided to the hospice member; general

inpatient hospice level of service will be reimbursed at the general inpatient rate and inpatient

respite hospice level of service will be reimbursed at the respite rate.)

• For members receiving inpatient care unrelated to the terminal illness, the facility is responsible

for the following:

➢ Obtaining PA, as required, from the MCE

➢ Submitting claims directly to the MCE for reimbursement

➢ All the member’s care and treatment while the member remains at the facility