N.H. Medicaid Hospice Provider Manual, Vol. II, § 10

Reimbursement for the NH Medicaid Hospice benefit follows the methodology and levels established by

the Centers for Medicare and Medicaid Services (CMS) for administration of the federal Medicare

Hospice Program. NH Medicaid hospice reimbursement rates are, therefore, based on Medicare

reimbursement rates and methodologies, adjusted to disregard offsets attributed to Medicare premium

amounts. The rates are adjusted for regional differences in wages using indices published by the CMS.

Payment for hospice care, with the exception of physician services, shall be at a per diem rate for each

day that the member is under the care of the hospice provider.

The per diem rate shall:

1. Be determined in accordance with Medicare regulations at 42 CFR 418, Subpart G;

2. For continuous home care, be calculated based upon the number of hours of continuous home

care furnished to arrive at a per diem rate, in accordance with 42 CFR 418.302(e)(4); and

3. Be based upon the level of care as follows:

•

Routine home care;

•

Continuous home care;

•

Inpatient respite care; and

•

General inpatient care

Payment for inpatient respite care shall be limited to one period of no more than 5 consecutive days in

each election period. Inpatient respite care provided in excess of the 5-day limit per election period shall

be paid at the routine home care rate.

If there is a change in designated provider, admission status, or level of care, payment shall be made as

follows:

1. If admission occurs on the same day as discharge, revocation or death, the day shall be considered

a hospice care day and the hospice shall be paid in accordance with the per diem rate noted

above;

2. If the level of care changes, payment shall be made for the new level of care beginning with the

day it commences;

3. If a change of hospice provider occurs, payment shall not be made to the discharging hospice for

the day of discharge, but payment shall be made to the newly designated hospice; and

4. If the member is discharged from an inpatient unit, the routine home care rate shall be paid,

unless the member dies as an inpatient, in which case the general inpatient or respite care rate

shall be paid for the discharge date.

If certification of terminal illness is not obtained as described in the “Provider Participation & Ongoing

Responsibilities” section of this manual, payment shall not be made for days prior to certification.

Bereavement counseling is part of the plan of care and shall not be separately billable to NH Medicaid nor

to the member’s family.