Va. DMAS Hospice Provider Manual ch. IV, Responsibilities Of The Hospice Provider For Individuals In Nfs Or ICFS/IDD

Once an individual, or his or her representative, has elected the hospice benefit, the

hospice provider becomes responsible for providing:

•

Skilled services, including but not limited to, the administration and monitoring

of narcotics therapy, wound care, total parenteral nutrition, physical therapy,

occupational therapy, and speech/language pathology services for treatment

and related conditions;

•

Care coordination, including, but not limited to, arranging routine appointments

and transportation to those appointments, ordering and ensuring receipt of

specialized equipment and supplies necessary to carry out the established

care of the individual, and ensuring timely physician visits and pharmacy

reviews;

•

Assessments and care planning by individual disciplines and timely updates;

•

Interdisciplinary team care planning and timely updates;

•

Quality management/utilization review and maintenance of medical records;

and

•

Submitting claims to DMAS for routine home care for fee-for-service, Medicaid-

only individuals. Revenue code 0658 must be billed by the hospice provider

in conjunction with either revenue code 0651 (routine home care) or 0652

(continuous home care), for FFS members.

Effective July 1, 2015, hospice providers furnishing services to nursing facility

residents must submit Resource Utilization Group (RUG) codes on the

revenue code 0022 line. Revenue code 0022 must be billed with revenue

code 0658.

For Mediacid members enrolled in the Cardinal Care program, nursing facilities

shall directly bill hospice related nursing facility services to the Cardinal Care

health plans. Providers should bill using the existing revenue code structure

for Medicaid nursing famility services, ie., using revenue code 190. These

claims will not differ from other Medicaid NF Resource Utiliztion Groups IV

(RUG-IV) Grouper 48 claims billed to CCC Plus health plans; NFs should not

bill managed care plans using hospice revenue codes.

Effective with dates of service 07/01/2019 and after, DMAS and Cardinal Care

plans will reimburse Hospice 100% of the Medicaid per diem rate for the

nursing facility, in addition to reimbursement for either routine or continuous

home care. The calculation of the per diem rate will be determined based on

the nursing facility rate associated with the dates of service.