Wash. HCA Hospice Services Billing Guide, What is client participation?

Client participation is an amount calculated by the Department of Social and

Health Services (DSHS) that the client must pay towards the cost of their Long-Term Service and Supports (LTSS) or hospice services. The following clients may

be required to pay participation:

• Hospice clients who reside in a nursing facility

• Hospice clients who reside in a hospice care center

• Hospice clients who received LTSS Home and Community-based services

• Hospice clients who live at home and are eligible under the special hospice

program and do not receive other long-term services and supports

If the client is assigned participation, the hospice agency is responsible for

collecting the client’s monthly participation amount stated in the notice of action

(award) letter sent by DSHS to the client.

If the client is on a Home and Community Based LTSS program, and is required to

pay participation, the LTSS provider, and not the hospice agency, is responsible

for collecting the client’s monthly participation amount and not the hospice

agency.

Do NOT use the participation amount in the Total Claim Charge

when billing HCA. Bill HCA your usual and customary charge. See

“How to indicate a client’s participation amount on your claim”

for instructions on how to indicate a client’s participation amount

on your claim.

Collecting and reporting the correct amount of the client’s participation is

the responsibility of the hospice agency.

• Report the client participation amount in the Value Code section using value

code 31.

• Do not factor the client participation amount into the billed amount. Bill the

full amount and report the participation amount using value code 31.

ProviderOne will automatically subtract the client’s participation amount.

The hospice agency collects the participation each month as directed by the

notice of action (award letter) issued by DSHS. A hospice agency may contract

with the nursing facility to collect the client’s participation, the amount is

reported using value code 31 as it is for all other hospice claims.