Mont. Medicaid Hospice Policy Manual, Policy 605

HOSPICE REIMBURSEMENT

BOARD

AND ROOM RATE

The “board and room” rate to be paid to a hospice for a Medicaid

member who is residing in a nursing facility will be the Medicaid

rate established by the Department in ARM 37.40.307, for the

individual facility minus the amount the member pays toward his

own cost of care. Payment for board and room will be made to the

hospice and, in turn, the hospice will reimburse the nursing facility

(refer to ARM 37.40.339).

General inpatient care or hospice respite care in a nursing facility

will not be reimbursed directly by Medicaid program when a

recipient elects the hospice benefit payment. Under such

circumstances payment will be made to the hospice in accordance

with ARM 37.40.805, 37.40.339.

INCLUDED

SERVICES

“Board and room” rate includes performance of personal care

services, including assistance in the activities of daily living,

socializing activities, administration of medication, maintaining

cleanliness of a member’s room, and supervision and assisting in

the use of durable medical equipment and prescribed therapies.

PHYSICIAN

SERVICES

The following services performed by hospice physicians are

included in the board and room rates described in this policy:

1. General supervisory services of the medical director;

and

2. Participation in the establishment of plan of care,

supervision of care and services, periodic review and

updating of plans of care, and establishment of

governing policies by the physician member of the

interdisciplinary group.

Services furnished voluntarily by physicians are not reimbursable.

Services of the patient’s attending physician if he or she is not an

employee of the hospice or providing services under arrangements

with the hospice are not considered hospice services and are not

included in the amount subject to the hospice payment limit.