Ind. IHCP Hospice Services Provider Reference Module, Section 6, Decertification of a Nursing Facility and Payment of Room and Board

When the Indiana Department of Health (IDOH) decertifies a nursing facility, the notification letter sent to

the facility specifies the effective date the IHCP reimbursement for nursing facility care (including hospice

room and board) must cease. CoreMMIS is updated to reflect the stop payment date. IHCP payment for

hospice revenue codes 650, 658 and 659 must also cease.

IHCP payment for any hospice services provided in a nursing facility is subject to the nursing facility

being certified by the IHCP. For example, if a nursing facility is decertified for the entire month of

October, the effect on hospice reimbursement is as follows:

• Hospice revenue codes 650 and 658 – Hospice per diem plus nursing facility room and board for

Medicaid-only hospice members is not reimbursed for the month of October.

• Hospice revenue code 659 – Room and board only for dually eligible (Medicare and Medicaid)

nursing facility hospice members is not reimbursed for the month of October.

The nursing facility is sent a notification letter indicating the effective date the IHCP reimbursement

ceases. Upon completion of the follow-up survey by the IDOH, the facility is sent a notification letter with

the findings. If the IDOH has recertified the facility for IHCP reimbursement, the notification letter

indicates the start date the IHCP reimbursement may resume.

While the hospice provider is not copied on the IDOH letters, the hospice does have the following

mechanisms to ensure notification of a nursing facility decertification:

• The hospice’s contract with the nursing facility can address notification procedures the nursing

facility must follow to inform the hospice regarding any change in certification, which affects IHCP

reimbursement and any involvement in the transfer or discharge of the resident to another certified

nursing facility.

• The patient is also notified by the local Division of Family Resources (DFR) office regarding the

nursing facility’s decertification.

When a nursing facility is decertified, the local ombudsman is also notified. The local ombudsman is

involved in working with the family and the nursing facility for the discharge or transfer of the resident to

another facility.

Hospice providers can check the IDOH website at in.gov/health to determine if a nursing facility has been

decertified.