Ind. IHCP Hospice Services Provider Reference Module, Section 8, Requirements for Billing Hospice Services Provided in a Nursing Facility

A member must have received prior authorization for hospice services and also must have been determined

to meet nursing facility LOC for the dates the hospice is requesting reimbursement for nursing facility

room-and-board services under the IHCP hospice benefit.

Note: When verifying eligibility on the IHCP Provider Healthcare Portal, providers must

confirm that both “Hospice Program” and “Nursing Facility Level of Care” are

listed in the Institutional Level of Care and Hospice panel for the member on the

date of service.

The Family and Social Services Administration (FSSA) Division of Aging has noted the following issues

with regard to nursing facility LOC for hospice members:

• Nursing facility staff submits a new LOC screen (via the state’s web-based PASRR system) for

IHCP nursing facility LOC when a nursing facility resident revokes hospice or the resident is

discharged from hospice care. If the resident has a current IHCP nursing facility LOC for Medicaid

reimbursement, the nursing facility does not need to resubmit a new LOC screen for nursing facility

LOC.

• The hospice is required by federal law to notify the state Medicaid agency when a member elects,

revokes, is discharged or changes providers under the Medicare and Medicaid hospice programs.

The hospice must submit a Medicaid revocation form or Medicaid hospice discharge form to the

IHCP prior authorization contractor so that the hospice LOC can be updated with these changes. If a

hospice fails to submit the Medicaid hospice revocation form or the Medicaid hospice discharge

form, then nursing facility claims will deny for service dates following the hospice revocation or

discharge because the member will still be identified as a hospice member in the IHCP eligibility

system.

Room and board under the IHCP hospice benefit is outlined at Indiana Administrative Code

405 IAC 1-16-4:

• Performing personal care activities (not otherwise performed by the hospice provider)

• Assisting with activities of daily living (ADL)

• Administering medication

• Socializing activities

• Maintaining the cleanliness of a patient’s room

• Supervising and assisting in the use of durable medical equipment and prescribed therapies

• While not explicitly listed at 405 IAC 1-16-4, the nursing facility should continue to provide all

dietary and laundry services for care of the nursing facility resident who elected hospice.

Skilled nursing facility (SNF) or nursing facility services offered to a patient or resident should be the same

whether or not they elected hospice. This means that if the member has a diagnosis or condition that is

unrelated to the terminal illness, the nursing facility must still provide that service.

It is the responsibility of the hospice as the manager for the patient’s end-of-life care to indicate in the

coordinated plan of care that the service is unrelated to the terminal illness. If the documentation does not

support this distinction between terminal and nonterminal illness, the hospice is subject to recoupment by

Medicare or Medicaid.