Wis. ForwardHealth Online Handbook, Hospice, Topic #1152

For each hospice, the total number of inpatient days (both for general inpatient care and inpatient respite care) must not exceed

20% of the aggregate total number of days of hospice care provided to all Medicaid members enrolled in the hospice during the

same period, beginning with services rendered November 1 of each year and ending October 31 of the next year. This limitation is

applied once each year, at the end of the hospice cap period. Inpatient days for persons with HIV diagnoses are not included in

these limitations.

If the aggregate number of inpatient days does exceed 20% of the aggregate total number of days of hospice care, the hospice is

required to reimburse Wisconsin Medicaid for the amount of reimbursement for days over the 20% cap. Wisconsin Medicaid will

notify the hospice of the amount to be refunded.

For the date of discharge from an inpatient unit, the appropriate routine or continuous care procedure code must be billed rather

than an inpatient code, unless the member dies as an inpatient. When the member is discharged as deceased, the general or respite

inpatient care procedure code must be billed for the discharge date.