Ind. IHCP Hospice Services Provider Reference Module, Section 8, Payment and Billing Parameters for Hospice and Nursing Facilities

The following table illustrates when nursing facility billing stops and when nursing facility billing resumes

for nursing facility care based a member’s IHCP hospice benefit status.

Table 10 – Hospice and Nursing Facilities Payment and Billing Parameters

Hospice Enrollment Status Hospice Billing Nursing Facility Billing

Hospice Election Hospice bills for room and

board starting the date of

hospice election

Nursing facility must stop

billing Medicaid the date of

hospice election

Hospice Revocation Hospice bills Medicaid for room

and board the date of hospice

revocation

Nursing facility resumes direct

Medicaid billing the day after

the hospice revocation

Hospice Discharge Hospice bills Medicaid for room

and board the date of hospice

discharge

Nursing facility resumes direct

Medicaid billing the day after

the hospice discharge

Nursing facility date of death or

date of resident’s physical

discharge from facility

Hospice must not bill date of

death or date of resident’s

physical discharge

Nursing facility regulations do

not permit payment for date of

death or date of resident’s

physical discharge from facility

Note from the CMS to the FSSA: Amounts paid to the nursing facility above 100% of the

Medicaid daily rate should be limited to nonroutine equipment, supplies and therapies that

are related to the patient’s terminal illness and paid to the nursing facility or an affiliated

supplier at cost or obtained from an independent supplier.