Wis. ForwardHealth Online Handbook, Hospice, Topic #3195

Accommodation Charges

The amount that a hospice agrees to pay a nursing home for accommodations for a hospice member is negotiated and established

by contract between the nursing home and hospice. Wisconsin Medicaid does not specify the contracted amount, although there

are federal contractual limits. Wisconsin Medicaid reimburses hospice services 95% of the SNF (skilled nursing facility) rate for

the DOS (dates of service) billed, regardless of the amount contracted for between the hospice and the SNF.

Bedhold

Wisconsin Medicaid does not reimburse the hospice for hospital bedhold if the member enters acute care.

DME and DMS

Wisconsin Medicaid does not allow a nursing home to bill the hospice for DME (durable medical equipment) or DMS (disposable

medical supplies), which are normally included in the nursing home's daily rate. Detailed listings of supplies and equipment

considered to be covered by the facility daily rate can be found in the DME Index and DMS Index. DME and DMS not covered

in the facility daily rate but related to the terminal illness are the financial responsibility of the hospice.

Patient Liability

Wisconsin Medicaid deducts the patient liability amount from the hospice's reimbursement for hospice members residing in a

nursing home. The nursing home is responsible for the following:

• Collecting liability from all Medicaid members, including hospice members, residing in their facility.

• Transferring the monthly available income to the member's hospice.

• Charging the hospice the contracted amount for room and board.

Nursing Home Room and Board for Hospice Members

Hospice providers submitting claims for room and board are required to indicate the nursing home room and board rate. For

hospice members who permanently reside in a nursing home, Wisconsin Medicaid reimburses the hospice for nursing home room

and board at 95% of the nursing home's current SNF rate, for either a non-developmentally disabled or developmentally disabled

resident.

The hospice is required to reimburse any provider with whom it has contracted for service, including a facility providing inpatient

care under Wis. Admin. Code § DHS 107.31(3)(d).

Retroactive Nursing Home Changes for Hospice Members

ForwardHealth automatically adjusts paid hospice claims for nursing home room and board if the nursing home's rate is changed

retroactively. ForwardHealth identifies claims for reprocessing and automatically adjusts them to the new rate associated with the

member's nursing home. Claim adjustments typically take 10–30 business days but can take longer if claim adjustments are

suspended for other reasons.

Submitting the hospice election properly will reduce claim and claim adjustment denials.