Kan. Medical Assistance Program Hospice Fee-for-Service Provider Manual § 8400, Reimbursement Criteria

KMAP reimbursement for hospice care will be made at one of four predetermined rates for each day in

which a member is under the care of the hospice. Physician services in excess of hospice physician

services will be billed and reimbursed in accordance with the benefits and limitations of KMAP. There

will be one attending physician designated for each hospice member.

Routine home care

The hospice is reimbursed at the routine home care rate for each day the patient is at home,

under the care of the hospice, and not receiving continuous home care. Routine home care is

paid without regard to the volume or intensity of services provided on any given day.

Continuous home care

• The hospice is reimbursed at a continuous home care rate when continuous home care is

provided. The continuous home care rate is divided by 24 in order to arrive at an hourly rate. A

minimum of eight hours per day must be provided. For every hour or part of an hour of

continuous care furnished, the hourly rate will be reimbursed to the hospice up to 24 hours a day.

• Continuous home care is covered when it is provided to maintain an individual at home during a

medical crisis. A period of crisis is a time when a patient requires continuous care (primarily

professional nursing care) to achieve palliation or the management of acute medical symptoms.

• Nursing care must be provided by an RN or LPN. The RN or LPN must be providing care for

more than half of the period of care.

• A minimum of eight hours of care must be provided during a 24-hour day which begins and ends

at midnight. The care need not be continuous (such as, four hours can be provided in the morning

and another four hours can be provided in the evening of that day). Homemaker and home health

aide services can also be provided to supplement the nursing care.

Inpatient respite care

The hospice is reimbursed at the inpatient respite care rate for each day the member is in an inpatient

facility, as previously defined, and is receiving respite care. Payment for respite care may be made

for a maximum of five days at a time (including the date of admission but excluding the date of

discharge) at the respite care rate.

General inpatient care

Payment at the inpatient rate is made when general inpatient care is provided. None of the other

fixed payment rates are applicable for a day on which the patient receives hospice inpatient care,

except for the day of discharge from an inpatient unit when the appropriate home care rate is to be

paid. When the patient is discharged deceased, the inpatient rate (general or respite) is to be paid for

the discharge date.

Reimbursement of hospice room and board on date of death

KMAP will reimburse room and board (T2046) on the date of death for a hospice member residing

in an NF, ICF/IID, and hospital swing bed. Regular payment rules continue on the date of death with

the additional payment being made to the hospice for room and board which is then paid out to the

NF, ICF/IID, or hospital swing bed.