Ind. IHCP Hospice Services Provider Reference Module, Section 6, Resident-Specific Add-Ons for Special Care Unit and Ventilator Services

Effective for dates of service on or after July 1, 2023, the IHCP reimburses resident specific add-ons for

special care unit (SCU) and ventilator services to qualifying nursing facilities and hospice providers when

applicable. A list of nursing facilities that the Office of Medicaid Policy and Planning (OMPP) has

determined qualify as special facilities eligible to receive these resident specific add-ons is posted on the

Myers and Stauffer website (under Nursing Facility > Schedule Z (SCU and Vent) Approved Provider

Listing).

This additional reimbursement, as well as the following billing requirements, applies to qualifying

specialized services delivered to eligible IHCP members enrolled in Traditional Medicaid (fee-for-service)

or in the Hoosier Care Connect or PathWays managed care programs.

Hospice providers are required to bill the nursing facility pass-through payment under the IHCP hospice

benefit using one of the following revenue codes:

• 650 – Routine home hospice care delivered in a nursing facility

• 658 – Continuous home hospice care delivered in a nursing facility

• 659 – Medicare/Medicaid dually eligible nursing facility hospice members only

When hospice providers bill room-and-board per diem charges for services rendered at a qualifying nursing

facility, they must designate the following revenue codes in an additional detail line for these add-on

services, when applicable:

• 193 – Special Care Unit residents with Alzheimer’s or dementia

➢ This SCU resident-specific add-on will be paid to qualifying facilities at a rate of $12 per

eligible Medicaid resident day.

• 199 – Ventilator-dependent residents

➢ This ventilator resident-specific add-on will be paid to qualifying facilities at a rate of $80 per

eligible Medicaid resident day.

Billing the room-and-board revenue code will generate the per diem rate reimbursement. The additional

detail line containing revenue code 193 or 199 will generate the resident-specific add-on payment (if

applicable).

Hospice providers continue to pay the nursing facility for the room-and-board pass-through per their

contract. The hospice provider must reimburse the nursing facility for the resident-specific add-on payment

if this payment was also made on the hospice claim. The hospice provider will receive 100% of the

reimbursement the nursing facility would have received for the nursing facility resident add-on payment.

The hospice must pass on this amount to the nursing facility but should not pass on more than the amount

received.