Ind. IHCP Hospice Services Provider Reference Module, Section 7, Recommendations for Medicaid-Only Hospice Members Residing at Home

The following recommendations help ensure nonhospice providers are notified that the individual is a

Medicaid-only hospice member:

• Instruct the hospice member or representative of the services covered under the IHCP hospice

per diem during the admission process.

• Instruct the hospice member or representative which nonhospice providers render hospice noncore

services under contract with the hospice agency. Also notify the hospice member the y are required

to use these services while under hospice care with that agency.

• Educate the hospice member or representative that failure to follow the hospice care philosophy or

to use a provider not under contract with the hospice makes the hospice member liable for all

charges resulting from the noncompliance as specified by Medicare and the IHCP.

Note: It is the hospice provider’s responsibility to ensure that nonhospice providers do not

bill either Medicare or the IHCP when the hospice member is noncompliant. See

Section 4: Hospice Election, Revocation and Discharge in this module for guidelines

about hospice revocation versus hospice discharge.

• Provide the hospice member or representative with a list of covered medications under the hospice

per diem. A new list should be provided each time the covered medications are revised per the

updated hospice plan of care.

• Provide the hospice member or representative with the patient care coordinator’s business card or

the business card of an appropriate hospice agency staff person. This card can be used to remind

nonhospice providers the member is under hospice care.

• Ensure the contract specifies coordination responsibilities between the hospice and pharmacy

provider so Medicare or the IHCP is not inappropriately billed for medications in the hospice plan

of care used for treatment of the terminal illness. The contract must specify the name and address of

the contact person for the hospice and the pharmacy provider so the pharmacy provider can contact

the hospice provider about which medications the pharmacy provider must bill.

• Hospice providers that contract any part of the hospice noncore services for treatment of the

terminal illness must ensure the contractor bills the hospice provider directly for those services.

Medicare or the IHCP must not be billed directly by these nonhospice providers as these services

are covered under the hospice per diem and are under the supervision of the hospice provider.

• As part of the admission process and subsequent hospice visits, the patient or the patient’s

representative must be asked whether any new provider or staff person is coming to see the patient

since the last visit. This information allows the hospice provider to follow up and develop a

coordinated plan of care with that entity.