Ind. IHCP Hospice Services Provider Reference Module, Section 5, Hospice Services for Hoosier Healthwise Members

Hoosier Healthwise members must be disenrolled from managed care prior to receiving hospice benefits.

Hoosier Healthwise members who elect to enroll in the IHCP hospice benefit become eligible for hospice

care the day following disenrollment from the managed care program.

To facilitate the hospice authorization process, the hospice provider may fax the Medicaid Hospice Election

form (accessible from the Forms page at in.gov/medicaid/providers) to the IHCP FFS PA-UM contractor at

800-922-9805 to initiate the disenrollment of the member from managed care.

It is imperative that hospice providers type Hospice Member Disenrollment from Managed Care on

the cover page of the fax. After submitting the fax, hospice providers must call the FFS PA-UM contractor

at 866-725-9991, to notify the FFS PA-UM staff that a fax was sent for disenrollment of a hospice member

from managed care, and confirm that the hospice analyst received the fax. This practice ensures the

disenrollment of the hospice member from managed care is completed in a timely manner and prioritized

within the overall workflow.

On receipt of the hospice enrollment information, the FFS PA-UM contractor contacts the appropriate

person at MAXIMUS, the IHCP’s managed care program enrollment broker, either on the same day or the

next business day if the fax is received after business hours. The hospice provider may start billing the

IHCP the day after the individual is disenrolled from managed care. Hospice providers are encouraged to

communicate with the IHCP FFS PA-UM contractor to make certain the FFS PA-UM contractor can

coordinate with MAXIMUS by 4 p.m. Eastern Time that same day to disenroll the member from managed

care. Coordination by 4 p.m. allows ample time for MAXIMUS to process the disenrollment on that day.

The corresponding Medicaid Hospice Physician Certification form and Medicaid Hospice Plan of Care

form (accessible from the Forms page at in.gov/medicaid/providers) must be sent to the FFS PA-UM

contractor within 10 business days, as outlined in 405 IAC 5-34-4 to ensure the request is timely. These

forms can be faxed to the FFS PA-UM contractor or submitted via the FFS PA-UM provider portal; see the

IHCP Quick Reference Guide for the PA-UM fax number, portal link and other contact information.

Special Batch Claims

The IHCP may special batch claims for hospice admissions when circumstances prevent same-day

disenrollment from managed care as follows:

• Weekend or holiday admission when the member dies during that same weekend or holiday, and the

hospice could not fax the Medicaid Hospice Election form to the FFS PA-UM contractor because

the contractor’s office is closed:

➢ The hospice must still meet the timeliness requirement of faxing the Medicaid Hospice Election

form by the 4 p.m. deadline on the first possible business day.

➢ For example, if the patient was admitted on Friday at 8 p.m., the Medicaid Hospice Election

form must be faxed to the FFS PA-UM contractor on the following Monday before the 4 p.m.

deadline.

• One-day admission to the hospice program when the member dies on the day of admission, or is

discharged from or revokes hospice care on the day of admission, and the FFS PA-UM contractor

could not have disenrolled the member even if the hospice faxed the form to the contractor on the

day of admission:

➢ The IHCP does not pay for room and board under the IHCP hospice benefit if the hospice

member dies or is physically discharged from the nursing facility on the day the member

elected hospice.

➢ When special-batch payment is warranted, the IHCP reimburses the hospice only for the hospice

per diem.

To meet the parameters for the special-batch payment, the hospice must be able to:

• Produce a copy of the Medicaid eligibility verification strip demonstrating the hospice checked

eligibility on admission per the IHCP Provider Agreement.

• Fax the Medicaid Hospice Election form and other paperwork to the IHCP FFS PA-UM contractor

on the first available business day so the contractor can perform a review for medical necessity.

• Complete the paper UB-04 claim form so that the FSSA may request that the FFS PA-UM

contractor process the claim by special batch.

The IHCP FFS PA-UM contractor notes on the Indiana Medicaid Prior Authorization Notification (PA

notification letter) the authorized dates for hospice care. The hospice provider must fax the PA notification

letter with a claim to the FFS PA-UM hospice analyst (see the IHCP Quick Reference Guide for the PA-UM fax number). The hospice analyst forwards the claim for special-batch processing. It is the

responsibility of the hospice to develop internal procedures to ensure that the individual who receives the

PA notice coordinates with the hospice biller on these payment issues. The hospice provider has six months

from the date of the written request to submit the documentation and hospice claim to the FSSA for special -

batch payment. If the provider does not submit the required documentation and hospice claim by the six-month deadline, no expenditure payout is issued.