Ind. IHCP Hospice Services Provider Reference Module, Section 7, Recommendations for Hospice Members Residing in a Nursing Facility

The majority of IHCP hospice benefit members reside in nursing facilities. The majority of these nursing

facility residents under hospice care are dually eligible for Medicare and Medicaid. Medicare Part A pays

for the hospice per diem for these members. Regardless of whether the nursing facility resident is dually

eligible or Medicaid-only, the IHCP must not be billed by nonhospice providers for any services covered

under the Medicare or IHCP hospice per diem.

Pharmacy providers can bill the IHCP directly for medications for a nursing facility resident. The IHCP has

the following recommendations to minimize the occurrences of pharmacy providers and other nonhospice

providers from billing the IHCP directly:

• Hospice providers and nursing facility providers must address this coordination and notification

process in their standard contracts. Specifically, the contract must do the following:

➢ Identify nonhospice providers that provide services to the nursing facility resident.

➢ Establish a mechanism to notify nonhospice providers that the nursing facility resident has

elected hospice.

➢ Indicate services and medications included in the hospice plan of care and covered by the

hospice per diem. Follow-up procedures should be identified to address those updates to the

hospice plan of care for any changes to the hospice member’s medications.

➢ Indicate the name and address of the contact person who will send this information so the

appropriate individual in the nonhospice provider’s billing department is notified that the

member is a dually eligible member or a Medicaid-only member.

• Hospice providers that have a contract with a particular pharmacy to provide medications for the

treatment of the terminal illness should ensure that the contract specifies coordination

responsibilities between the hospice and pharmacy provider. Making sure this information is

specified in the contract ensures that neither Medicare nor the IHCP is inappropriately billed for

medications identified in the hospice plan of care for treatment of the terminal illness. The contract

must include the name and address of the contact person for each provider.

• Hospice providers should ensure the coordination efforts are documented if the nonhospice provider

contacts the hospice provider for reimbursement of the IHCP overpayment.