Ind. IHCP Hospice Services Provider Reference Module, Section 6, Inpatient Admission or Outpatient Hospital Services for Nonterminal Conditions

If an IHCP hospice member requires inpatient admission or outpatient hospital treatment for conditions

unrelated to a terminal illness, the hospital should obtain PA for any such services that require PA prior to

billing. The hospital should then bill the IHCP directly for those services using the UB-04 claim form or

electronic equivalent (IHCP Portal institutional claim or 837I transaction).

A hospice provider’s coordination responsibilities for treatment of a nonterminal condition are case -

specific; however, the following guidelines should provide direction for hospice providers:

• If the hospice member currently does not receive treatment for the nonterminal condition, then the

hospice provider should make arrangements to find a hospital where the hospice member may

receive treatment for the nonterminal condition on an inpatient or outpatient basis, if necessary.

• To ensure that the hospice member is not billed for those hospital services, the hospice provider

should make sure that the hospital-based physicians, the hospital’s other medical providers and the

hospital itself are enrolled as IHCP providers.

• The hospice provider must communicate and coordinate with the nonhospice provider’s personnel

to ensure that any treatment for the nonterminal conditions does not compromise the member’s

hospice care.

• If the hospice member is admitted to a hospital from home (any residential setting other than a

nursing facility), the hospice provider must submit a Change in Status of Medicaid Hospice Patient

form to the PA-UM contractor, reflecting the hospice member’s change in residence. The same form

must be completed after the hospice member is discharged from the hospital to either another

institutional care setting or a private home.