Kan. Medical Assistance Program Hospice Fee-for-Service Provider Manual § 8400, Hospice Levels of Care Defined

Hospice providers are paid a per diem rate based on the number of days and level of care provided during

the election period.

Routine home care: A routine home care day is a day on which an individual who has elected to receive

hospice care is at home and is not receiving continuous home care.

The payment methodology for Hospice Routine Home Care (HRHC) includes two rates that will result in

a higher base payment for the first 60 days of hospice care and a reduced base payment rate for days

thereafter. Days 1 through 60 will be paid at the HRHC “high” rate while days 61 and after will be paid at

the HRHC “low” rate.

A hospice day billed at the HRHC level of care will be paid one of two rates based upon the following:

• The day is billed as a HRHC level of care day.

• If the day occurs during the first 60 days of an episode, the HRHC rate will be equal to the

high rate.

• If the day occurs on day 61 or after, the HRHC rate will be equal to the low rate.

• For a hospice patient who is discharged and readmitted to hospice within 60 days of that

discharge, the patient’s prior hospice days will continue to follow him or her and count toward his

or her patient days for the receiving hospice in the determination of whether the receiving hospice

can bill at the high or low HRHC rate upon hospice election.

• For a hospice patient who has been discharged from hospice care for more than 60 days, a new

election to hospice will initiate a reset of the patient’s 60-day window, paid at the HRHC high

rate upon the new hospice election.

Providers must bill procedure code T2042 for the first 60 days of hospice care and procedure code T2042

with modifier U2 for hospice care beginning on the 61st day.

Continuous home care: A continuous home care day is a day on which an individual who has elected to

receive hospice care is not in an inpatient facility (hospital, SNF, or hospice inpatient unit) and receives

hospice care consisting predominantly of nursing care on a continuous basis at home. Hospice aide or

homemaker services or both may also be provided on a continuous basis. Continuous home care is only

furnished during brief periods of crisis and only as necessary to maintain the terminally ill patient

at home.

Inpatient respite care: An inpatient respite care day is a day on which the individual who has elected

hospice care receives care in an approved facility on a short-term basis for respite.

General inpatient care: A general inpatient care day is a day on which an individual who has elected

hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic

symptom management which cannot be managed in other settings.

SIA for end-of-life care

Medicaid covers a Service Intensity Add-on (SIA) payment for end-of-life care. The SIA payment will be

made for a visit by a registered nurse (RN) or social worker (SW) when provided during routine home

care in the last seven days of life. The SIA payment is in addition to the routine home care rate. The

following procedure codes are used: G0299 with modifier U2 (RN) and G0155 (SW). Both codes are

designated for 15-minute intervals.

Providers can submit claims for SIA end of life care if the following criteria are met:

• The day is a HRHC level of care day.

• The day occurs during the last seven days of life (and the member is discharged deceased).

• Service is provided by an RN or SW that day for at least 15 minutes, up to 4 hours total, not to

exceed 16 combined 15-minute increments per day.

• The service is not covered if provided by a social worker via telephone.

Hospices are expected to furnish these services to the extent specified by the plan of care for

the individual.