MHCP Provider Manual, Hospice Services, Hospice Payments and Limits

MHCP will pay a hospice provider for each day a member is under the hospice's care. The payment methodology and amounts are the same as those used by the Medicare program.

Hospice providers are paid at one of the four fixed daily rates that apply to all services except certain physician services and room and board in a long-term care facility. Refer to the current Minnesota Department of Human Services Hospice Rates (DHS-7275) (PDF) table for the established Core Based Statistical Area (CBSA) rates by location and level of service. The published Hospice Rates (DHS-7275) (PDF) table reflects the base rate. Legislative add-ons or reductions may apply. Refer to the Payment Methodology - Non-Hospital section of the MHCP Provider Manual. Providers should bill their usual and customary charges.

The limits and cap amounts are the same as those used in Medicare except that the inpatient day limit on both inpatient respite days and general inpatient days do not apply to members with AIDS.

The hospice provider may be paid for an amount that does not exceed the hospice cap payment. Room and board payments for a long-term care facility and certain payments to the member’s attending physician are not considered when the cap amount is calculated.

Claims for Routine Home Care, (revenue code 0651)

A higher CBSA rate will be applied to claims for days 1–60 of hospice election, and a lower CBSA rate for days 61 and over.

Service Intensity Add-on (SIA): (revenue code 0551–registered nursing visit, or revenue code 0561–social service visit)

In addition to the established RHC payment for each day of hospice care, hospice providers may also bill for SIA payment for face-to-face services they provide during the last seven days of life by a registered nurse or social worker. Social worker phone calls are not eligible for payment. SIA payments allow a combined total of 16 units per day (1 unit equals 15 minutes). Registered nurse and social worker services can be billed on the same claim using separate lines for each day of service. (Refer to the Billing section for additional details.)

SIA payments will be paid at 25 percent of the hourly Continuous Home Care CBSA rate for each 15-minute unit, not to exceed 16 units per day.