Ind. IHCP Hospice Services Provider Reference Module, Section 6, Payment for Nursing Facility Residents

The routine and continuous care hospice reimbursement methodologies make a distinction between care

provided in a nursing facility versus a home setting (any residential setting other than a nursing facility),

because hospice residents in an IHCP-certified nursing facility require an additional room-and-board per

diem, which is paid directly to the hospice provider. To comply with Indiana Administrative Code 405 IAC

1-16-4, when an IHCP member is admitted to a nursing facility for hospice services, in addition to the

routine or continuous care hospice reimbursement amount, the IHCP must pay the hospice provider a

room-and-board payment that is equivalent to 95% of the nursing facility’s daily rate for those dates of

service on which the member was a resident. This additional payment applies to both fee-for-service (FFS)

claims as well as applicable managed care claims.

The hospice provider is responsible for paying the nursing facility according to their contract. The contract

must be in compliance with federal and state regulations.

Myers and Stauffer LC, is the long-term care (LTC) rate-setting contractor and sets the IHCP rates for

nursing facilities, hospices, home health agencies and group homes. Hospice providers can obtain current

rate information for a particular nursing facility from the Myers and Stauffer’s LTC website as follows:

1. Go to the Myers and Stauffer website at myersandstauffer.com/client-portal/indiana.

2. Click Long-Term Care to go to the Long-Term Care page.

3. Under the Nursing Facility section, click the + to expand the Other Reports folder.

4. Click Cumulative Listing – Nursing to download a report listing Medicaid rates for all Medicaid-certified nursing facilities.

Medicaid rates are updated within 24 hours of the finalization.