Mich. Medicaid Provider Manual, Hospice § 7.3.E

If the Medicaid beneficiary residing in a NF has a patient-pay amount (PPA), the hospice

must collect that amount each month and apply it toward the beneficiary’s Medicaid

covered services, and non-covered services as allowed by Medicaid. While the hospice is

responsible for collecting the PPA, this duty may be delegated to the NF (via contract

with the hospice) as long as the amount is applied to the room and board bill. The PPA

must be exhausted each month (even if services do not span the entire month) before

any Medicaid payment can be made. Whenever the hospice collects a PPA, a receipt

must be given to the beneficiary (or family).

The provider must bill Medicaid for services rendered even if the PPA exceeds the

Medicaid reimbursement rate resulting in a zero dollar payment. The Hospice Claim

Completion Section of the Billing & Reimbursement for Institutional Providers Chapter

contains examples of the application of the PPA.

CHAMPS handles the PPA in the following manner: When a beneficiary has a monthly

PPA and a corresponding nursing facility and hospice PET (i.e., HOS-NFAC), the PPA will

be deducted from the first claim received in CHAMPS, resulting in deduction of the higher

PPA amount. If the PPA is greater than the amount of the first submitted claim, the

difference will be applied to subsequent claims until the total PPA for that month is met.

The PPA must be exhausted each month before any Medicaid payment will be made.

The nursing facility and hospice must bill in sequence according to the location of the

beneficiary at the first of the month. This will prevent the PPA from being deducted from

the wrong claim.

Providers have the ability to verify the PPA on the Member Eligibility Detail page in

CHAMPS.