Ind. IHCP Hospice Services Provider Reference Module, Section 8, Hospice Conditions of Participation

The hospice conditions of participation codify the care standards in nursing facilities by incorporating Code

of Federal Regulations 42 CFR 418.112: Condition of Participation: Hospices That Provide Hospice Care

to Residents of a SNF/NF or ICF/IID. The care expectations are consistent with the information in this

module.

State law requires the IHCP hospice program to mirror the coverage and reimbursement methodology of

the Medicare hospice program.

The hospice provider is required to adhere to certain contractual responsibilities when entering a contract

with a nonhospice provider for a service related to the member’s terminal illness or related conditions. The

contract requires the nonhospice provider to bill the hospice for those services at the fair market value rate

noted in the contract. The nonhospice provider must not bill the IHCP for those services separately,

because it would be considered duplicate billing and subject the nonhospice provide r to recoupment.

It is important that the hospice consult with an attorney for all contractual issues and to ensure that the

contracts are compliant with the safe harbor laws. Hospice providers can address the following issues in

their contracts:

• Specification of what is included in room-and-board services and whether the hospice pays 95% or

100% of the nursing facility daily rate

• Specification of additional hospice noncore services and the rates the hospice will pay for each

• Specification whether the hospice is the manager of the resident’s hospice care and as such the

nursing facility must seek authorization from the hospice provider for any change to the agreed-upon plan of care

• Procedures for hospice to provide regular in-service training to the nursing facility staff regarding

the hospice care philosophy

• Notification sections specifying the name of the contact person for each entity

• Specification indicating room and board under the Medicaid hospice benefit cannot be made for

dates of service the resident was ineligible for the Medicaid hospice benefit, did not have Medicaid

nursing facility level of care, or the nursing facility was decertified from the Medicaid program

• Notification procedures for the nursing facility to inform the hospice when an approved

authorization is issued via the Preadmission Screening and Resident Review (PASRR) process.

• Notification procedures a nursing facility must follow to inform the hospice about Medicaid

decertification as a result of an Indiana Department of Health (IDOH) survey, which may also

include hospice participation in the discharge/transfer of a resident to another Medicaid-certified

facility

• Attendance of appropriate hospice staff at nursing facility interdisciplinary team meetings and

attendance of appropriate nursing facility staff at hospice interdisciplinary meetings

• Billing and payment parameters between hospice and nursing facility

• Specification of the respective care responsibilities of hospice and nursing facility staff based on a

detailed description of the hospice level of service and the nursing facility room-and-board services

under the Medicaid hospice benefit

• Procedures that must be followed by hospice and nursing facility staff when a resident under

hospice care requires hospitalization for either the terminal illness or the nonterminal illness; for

example, nursing facility must contact hospice for authorization, determination of which hospital the

resident will be admitted, the billing and payment parameters, and so forth

• Procedures for the disposal of medications after the hospice member dies