Ind. IHCP Hospice Services Provider Reference Module, Section 6, Payment for Briefs for Hospice Patients in Nursing Facilities

Briefs are and have been included in the room-and-board portion of Medicaid hospice benefits since 1997.

Hospice providers have long expressed concerns to the IDOH and FSSA that providing briefs for care

related to the terminal illness or related conditions for hospice patients in a nursing facility could be

construed as fraud or kickback, as briefs are considered part of the room and board per diem of Medicaid

hospice benefits; however, some hospices do provide briefs for care of the terminal illness for ALL hospice

patients regardless of payer source as a matter of their policy.

Representatives from CMS Baltimore on the Medicare and Medicaid Hospice Operations provided the

following clarification January 2008:

If the briefs etc. are used as an inducement i.e. to obtain referrals; it would not comply with

Medicare requirements and should be referred to the state OIG. IF it is a practice and part of

the hospice’s policy to provide briefs, etc. to ALL patients regardless of payer source or as a

response to referrals, there doesn’t appear to be anything that affects the Medicare hospice

benefit’s statute or regulations.

One additional point, my response pertained ONLY to the Medicare hospice benefit. In other

words, if a patient is a resident of the nursing facility and is receiving Medicare hospice care

and if the terminal or related condition requires briefs and the hos pice provides briefs for ALL

patients that require briefs regardless of payer source or where the care is provided, there does

not appear to be a prohibition, even though briefs are not considered a covered item under

Medicare. However, it would seem that briefs would be part of room and board and thus

covered under Medicaid in a nursing facility or by the patient in his/her home.

If briefs are supplied by a hospice to only nursing facility patients in return for referrals, that

would be prohibited.