Ind. IHCP Hospice Services Provider Reference Module, Section 6, Routine Home Hospice Care

Medicare hospice rule CMS 1629-F establishes two rates for routine home hospice care:

• A higher per diem rate applies to routine home hospice care rendered during the first 60 days of care

• A reduced per diem rate applies to routine home hospice care rendered on days thereafter.

If a patient has a live discharge from hospice and then is readmitted within 60 days, the 0–60 and 61+ day

count will continue from the previous date of discharge. If the patient has a live discharge from hospice and

then is readmitted at day 61 or later, the count will start over.

See the following examples of reimbursement at the new rates:

Example 1:

A member is in hospice for 58 days and then discharged. The member is then readmitted to

hospice seven days later. Upon readmission, the count of patient hospice days will begin at day

59. Routine home hospice care services rendered on days 59–60 will be paid at the higher rate;

routine home hospice care services on days 61 and after will be paid at the lower rate.

Example 2:

A member is in hospice for 45 days and is then discharged. The member is then readmitted to

hospice 65 days after discharge. Upon readmission, the count of hospice patient days will begin

at day 1. Routine home hospice care services rendered on days 1-60 will be paid at the higher

rate; routine home hospice care services on days 61 and after will be paid at the lower rate.

Medicare hospice rule CMS 1629-F also establishes a service intensity add-on (SIA) payment for face-to-face services provided by a registered nurse (RN) or social worker during the last seven days of a member’s

life. See the Service Intensity Add-On Payments section.

Delivered in the Home

The IHCP reimburses the hospice provider at the routine home care rate for each day the member is at

home (any residential setting other than a nursing facility), under the care of the hospice provider and not

receiving continuous home hospice care. This rate is paid without regard to the volume or intensity of

routine home hospice care services on any given day.

Delivered in a Nursing Facility

The IHCP reimburses the hospice provider at the routine home care rate for each day the member is in a

nursing facility, under the care of the hospice provider and not receiving continuous home hospice care.

This rate is paid without regard to the volume or intensity of routine hospice home care services on any

given day.

In addition, the hospice provider is paid an additional room and board per diem at 95% of the single

nursing facility case-mix rate to cover costs incurred by the contracted nursing facility.