Utah Medicaid Provider Manual, Hospice Care Services § 13-1

Hospice care services (including room and board) are reimbursable to the

hospice agency. Medicaid payments for hospice care services are based on the

methodology used in setting Medicare rates, adjusted to disregard cost offsets

attributable to Medicare coinsurance amounts. However, Medicaid will not apply

the aggregate caps used by Medicare. The rates will be based on the Medicare

rates for Utah which are unique to each geographic region in the state. Providers

should bill the rate that applies to the geographic region where the member

resides, not the geographic region of the provider’s address.

Medicaid establishes reimbursement rates for the following categories:

• Routine home care,

o Room and board is reimbursed separately from the routine home

care rate when a member resides in a nursing facility, ICF/ID, or

freestanding hospice inpatient units.

o Service intensity add-on is also reimbursed separately from the

routine home care rate.

• Continuous home care,

• Inpatient respite care, and

• General inpatient care.

Reimbursement is made for only one of the categories of hospice care listed

above for any day.

Additional information on hospice care rates and date of discharge

reimbursement can be found in 42 CFR 418.302 Payment procedures for hospice

care., Utah Administrative Rule R414-14A-6 Reimbursement, or Utah Medicaid

State Plan Attachment 4.19-B page 28.