MO HealthNet Hospice Provider Manual § 2.3

It is a federal requirement that the MHD payment to a NF or intermediate care home be reduced by a participant's income less certain deductions; personal expenses, medical insurance, etc. This income is called patient liability or patient surplus and is computed by the Family Support Division (FSD). The patient’s liability/surplus amount must be applied to the hospice room and board payment when a participant who has been certified as needing NF or intermediate care home level of care elects hospice while the participant is a resident of a MO HealthNet certified NF intermediate care home or when a participant who has elected the hospice benefit enters a MO HealthNet certified NF or intermediate care home.

Patient surplus is not applied the first month a participant enrolled in hospice is admitted to a MO HealthNet certified NF or intermediate care home if admission is any date after the first day of the month. If admission is the first day of the month, then the patient surplus is applied for that month. If nursing home room and board is billed for any portion of a month, surplus is applied to all subsequent months even if the participant is not in the facility on the first day of the month. This policy also applies in situations where a participant changes NFs or intermediate care homes during a subsequent month.

The participant or the participant's representative is responsible for paying the surplus amount to the hospice so it can be applied toward the participant's room and board charge. The hospice may enter into a contractual agreement with the NF or intermediate care home whereby the facility collects the surplus from the participant or the participant's representative.

The applicable patient surplus amount is deducted from the MO HealthNet allowable room and board reimbursement for each month the participant continues to reside in the NF or intermediate care home.

Monthly Billing for Nursing Facility Room and Board

Hospice facilities must submit one (1) bill per month for any participant in a NF for whom a surplus or liability amount applies. When the hospice patient has a surplus or liability amount, the surplus is subtracted from the allowed amount of the NF room and board claim.

When billing for more than one (1) month of hospice NF or intermediate care home, the provider must submit a separate claim form for each month of service.

MHD does not reimburse NFs for the date of discharge to home, transfer to a hospital or another facility, or for the date of death.; therefore, the hospice provider must not bill room and board charges to MHD for the date of discharge from the facility.However, if the patient resides in the nursing facility when they elect hospice and are discharged from hospice, but remains in the nursing facility, the hospice provider is responsible for billing room and board for the date the patient discharges from hospice care. This is because the nursing facility is unable to submit a claim for that date of service while the patient is still recorded as enrolled in hospice.

Additionally, hospice providers may bill for routine home care or continuous home care provided to the participant on the date of discharge from the facility or from hospice care. Refer to Section 2.12 in this manual for more information.