Ind. IHCP Hospice Services Provider Reference Module, Section 6

Reimbursement for the Indiana Health Coverage Programs (IHCP) hospice benefit follows the

methodology and amounts established by the Centers for Medicare & Medicaid Services (CMS) for

administration of the federal Medicare program. Services are reimbursed at one of five all-inclusive

per diem rates (based on level of service) for each day in which a member is in hospice:

• Routine home hospice care (days 1-60)

• Routine home hospice care (days 61+)

• Continuous home hospice care

• Inpatient respite hospice care

• General inpatient hospice care

Note: The IHCP announces hospice rates annually. Providers can go to the IHCP Bulletins

page at in.gov/medicaid/providers to view bulletins. Search “hospice” for the most

current publication containing hospice rates.

Effective July 1, 2024, the same rates used for the Traditional Medicaid hospice

benefit also apply to hospice services covered under a managed care program.

IHCP hospice reimbursement rates are based on Medicare reimbursement rates and methodologies,

adjusted to disregard offsets attributable to Medicare premium amounts. The rates are further adjusted for

regional differences in wages, using indices published by the CMS. An additional room-and-board

per diem, based on the nursing facility’s case-mix rate, is available for routine home hospice care and

continuous home hospice care delivered in a nursing facility.

Certain add-on payments may be available, in addition to the per diem rate, as described in the Service

Intensity Add-On Payments and Resident-Specific Add-Ons for Special Care Unit and Ventilator Services

sections. Direct patient services rendered by a hospice-employed physician may also be separately

reimbursable, as described in the Physician Services Under Revenue Code 657 section.

For fee-for service (FFS) hospice members, hospice providers follow the general directions outlined in the

Claim Submission and Processing module for completing the UB-04 claim form or electronic equivalent,

along with the hospice-specific billing information in this module. Providers are to use type-of-bill code

081x or 082x when billing for hospice services.

Submit FFS hospice claims electronically, using the IHCP Provider Healthcare Portal (IHCP Portal) or 837

transaction, or mail paper claim forms to the following address for processing:

Gainwell – UB-04 Claims

P.O. Box 7271

Indianapolis, IN 46207-7271

Note: Gainwell P.O. boxes will be changing, effective Aug. 1, 2024. The new address for

FFS hospice claims will be:

Gainwell – UB-04 Claims

PO Box 50448

Indianapolis, IN 46250-0418

For Healthy Indiana Plan (HIP), Hoosier Care Connect and Indiana PathWays for

Aging (PathWays) members, hospice claims should be submitted to the appropriate

managed care entity (MCE), in accordance with that MCE’s established billing

procedures. See the IHCP Quick Reference Guide for contact information.