Ind. IHCP Hospice Services Provider Reference Module, Section 6, Payment for Date of Discharge

The Indiana FSSA pays 95% of the nursing facility per diem rate for the hospice member’s day of

admission to the facility. The FSSA does not pay the nursing facility per diem or nursing facility room-and-board services for the day a hospice member is discharged from the facility.

When a hospice member dies in a nursing facility, the hospice member’s date of death follows the same

reimbursement procedures as the date of physical discharge from the facility. Hospice claims that include a

member’s date of death require using patient status discharge code 20, 40, 41 or 42. Providers are required

to report occurrence code 55 for members discharged as deceased. If a hospice member is admitted to the

nursing facility and dies on the day of admission, the facility is not paid for room-and-board services

for that day. These reimbursement procedures for hospice members residing in nursing facilities are

consistent with current IHCP reimbursement for nursing facility covered services.

Hospice providers are reimbursed the hospice per diem according to the hospice member’s level of service

on the day of the hospice member’s admission to the nursing facility and the day the hospice member is

physically discharged from the facility. The reimbursement procedures for hospice providers are consistent

with current Medicare and IHCP guidelines for the Medicare and the IHCP hospice benefit.

The following IHCP reimbursement procedures apply to hospice providers and nursing facility providers

when the hospice provider discharges the hospice member from hospice care or the hospice member

revokes hospice care, but the IHCP member physically remains in the nursing facility:

• The hospice provider must still bill the IHCP for nursing facility room-and-board services and the

hospice per diem for the date of hospice discharge or the date of hospice revocation because the

hospice member is still under hospice care on those dates of service.

• The nursing facility can resume billing the IHCP directly for nursing facility care on the day after

hospice discharge or hospice revocation because the IHCP member has resumed nursing facility

care on that date.

It is appropriate for transition-related Home- and Community-Based Services (HCBS) waiver services to be

provided on the same day as long-term care client discharges. Provision of certain HCBS waiver services to

clients with hospice level of care may also be appropriate. Payment for services provided under either of

these circumstances will be systematically denied unless specially handled. Providers submitting claims for

waiver services on the client’s date of discharge from the long-term care facility or during a period of

hospice level of care should contact their Provider Relations field consultant for special claim handling.

Providers that have had claims previously denied for these reasons should also contact their field consultant

for special handling.