Kan. Medical Assistance Program Hospice Fee-for-Service Provider Manual § 8400, Hospice Coverage in Nursing Facilities

• KMAP will reimburse room and board services for eligible members who reside in NFs that

participate in KMAP. Providers will be reimbursed at 95% of the per diem rate that Medicaid

would have paid to the NF for the individual in the facility as state plan benefit. Reimbursement

will be provided when a member elects hospice benefits and the hospice and facility have a

written agreement under which the hospice is responsible for the professional management of the

member’s hospice care and the facility agrees to provide room and board. The room and board

component of hospice coverage is a KMAP-covered service. Payment is made to the hospice for

room and board, in addition to routine home care and continuous home care, for those who have

elected hospice coverage. No payment will be made to the NF.

• The NF/ICF or ICF/IID must not bill KMAP during the hospice-election time frame. Entering

NF/ICF or ICF/IID dates of service (DOS) which overlap with hospice dates on any portion of a

claim will result in the entire claim being denied.

• For UB-04 claims, the entire claim will be denied based on the header DOS. However, the edit

will post on each detail regardless of whether the detail DOS is within the hospice assignment.

Services provided during the dates of a member’s hospice assignment must be billed separately

from services provided outside the hospice assignment period.

• Routine nursing facility supplies are content of the per diem room and board

reimbursement. For items considered to be routine for hospice patients, refer to Section 8400 of

the Nursing/Intermediate Care Facility Fee-for-Service Provider Manual.