Mich. Medicaid Provider Manual, Hospice § 3.4.B

When a dually enrolled Medicare/Medicaid beneficiary enters a nursing facility (NF), the

beneficiary can elect the Medicare hospice benefit if that NF has hospice services

available. In this case, the beneficiary revokes the 100 days of Medicare reimbursement

for skilled NF care.

Revocation of the 100-day NF skilled care is a beneficiary’s decision and should not be

influenced by the NF’s funding source for the bed.

The CHAMPS application process is used to complete the beneficiary’s election for

hospice and create the correct PET (e.g., HOS-NFAC) for Medicaid eligible beneficiaries.

This does not mean that the beneficiary has revoked the Medicare benefit for services

not related to their terminal illness. The beneficiary remains eligible for Medicare, but

has elected to use only the hospice portion of the Medicare benefit.

If the NF contracts to make hospice services available, the hospice must complete the

admission in CHAMPS for all Medicaid, Medicare and dually eligible beneficiaries. The

facility must provide room and board for the beneficiary, and the hospice must provide

its normal services.

The Pre-Admission Screening/Annual Resident Review (PASARR) form (DCH-3877) must

be completed for a hospice patient entering a NF unless the hospice beneficiary is

entering for a five-day respite period. The DCH-3877 is not required for the respite

period. The DCH-3877 is to identify individuals who may have a mental illness,

intellectual/developmental disability or a related condition. If the patient is on

psychotropic medications for purposes of pain control/symptom relief for end of life, it

should be noted on the DCH-3877. This allows the Community Mental Health Services

Program (CMHSP) worker to better evaluate the need for further (Level II) screening. If

the patient is on any of the above mentioned psychotropic medications for a related

mental illness, the CMHSP will determine the need for a Level II screening.

Medicaid will reimburse the hospice for room and board for a hospice beneficiary who

resides in a NF (including a beneficiary for whom a complex care authorization has been

approved) or in a Ventilator Dependent Care Unit (VDCU). The hospice then reimburses

the NF. The Medicaid reimbursement to the hospice for NF room and board is equal to

95% of the total Medicaid NF rate. For Class I, III, and V facilities, reimbursement also

includes 100% of the Quality Assurance Supplement (QAS) amount due the NF through

the Quality Assurance Assessment Program (QAAP). QAS funds are not included in the

reimbursement for Hospital Swing Beds as they are not eligible for that program.

Per Medicare guidelines, the term "room and board" in a NF includes the performance of

personal care services that a family caregiver would provide if the individual were at

home. This includes assistance in the activities of daily living such as bathing, grooming,

toileting, dressing, meal service, socializing, companionship, hobbies, administration of

medication, maintaining the cleanliness of the beneficiary’s bed and room, and

supervising/assisting in the use of durable medical equipment (DME) and prescribed

therapies (e.g., range of motion, speech and language exercises). The NF may not

include hospice staff to meet its staffing requirements.

Hospice covered beneficiaries residing in the NF must not experience any lack of NF

services or personal care due to their status as a hospice beneficiary. NFs must offer the

same drugs, services, medical supplies and DME to all residents who have elected the

hospice benefit in the same manner that services are provided to other residents in the

facility who have not elected hospice care. If a service is normally furnished as part of

the facility’s per diem, the service must also be provided to hospice beneficiaries. If

services are provided for needs associated with a non-terminal illness and are normally

furnished and billed by another provider, that practice would continue.