MHCP Provider Manual, Hospice Services, Hospice Services for Residents of Long-Term Care Facilities (LTCF)

MA-eligible residents of intermediate care facilities for the developmentally disabled (ICF/DDs) or nursing facilities (NFs) who become eligible for hospice services may elect to receive those services in the facility where they live. Refer to Bed-hold information when a hospice patient resides in a nursing home and is absent from the nursing home for hospitalization, home visits, etc.

The elected hospice provider must notify the local county human services agency of the member’s hospice election by sending (or faxing) a copy of the Hospice Transaction Form (DHS-2868) (PDF) to the county. The elected hospice provider will become the designated provider for the medical spenddown. The payment to the hospice for the room and board will exclude the amount of the member’s medical spenddown.

The elected hospice and the LTCF must coordinate the care and service that each will provide to the member according to the members plan of care, negotiate a rate and enter into a contract with the facility. The elected hospice provider may negotiate that the LTCF will continue to collect the member’s spenddown.

The LTCF will bill the elected hospice the contracted amount and the elected hospice will be responsible to pay the LTCF the agreed upon amount as indicated in the contract.

Medicare and MHCP will make payments to the elected hospice provider. For dual eligible members, the elected hospice will bill Medicare as the primary payer for hospice services provided to dual eligible members and bill MHCP for the LTCF room and board regardless of whether the member is on MA or a managed care program: Minnesota Senior Health Option (MSHO), Minnesota Senior Care Plus (MSC+), Special Needs Basic Care (SNBC).

Current law requires a payment to the hospice provider of at least 95 percent of the rate that would have been paid for facility services for the member. Payments that MHCP will make are indicated in column (E) of the hospice payment rate table.

Hospice payment rates

Column A: Facility Type Column B: DHS Payment Rate Column C: Percentage of Rate Column D: Private Room Column E: Hospice Payment for Room and Board

ICF/DD ICF/DD 100% 95% * [(B)*(C)]

NF NF Case Mix 100% 95% * [(B)*(C)]

NF NF Case Mix 100% 111.5% 95% * {[(B)*(D)]*(C)}

NF First 30 days1 NF Case Mix 120% 95% * [(B)*(C)]

NF First 30 days1 NF Case Mix 120% 111.5% 95% * {[(B)*(D)]*(C)}

Out-of-state NF NF Rate 100% 95% * [(B)*(C)]

1 Begins with date of NF admission, not MA eligibility date.

Note: Residents of ICF/DDs and NFs may receive end-of-life care from their residential provider without making the hospice election. Facilities may be able to arrange for the specific care needs of people with terminal illness by making internal staffing adjustments, by adding staff, or by purchasing the specialized services. ICF/DD facilities may apply through their host counties for a variable rate adjustment to accommodate the increased needs of a person with terminal illness.