Wyo. Medicaid Institutional Provider Manual § 16.1.4

For Members residing in the nursing facility, the hospice Provider is responsible for billing the room and

board charges, and reimbursing the nursing facility for their portion of the care. The hospice Provider

must request a rate for nursing home care by completing the Hospice NH Room & Board Form (see

Section 16.1.1.2 Hospice NH Room & Board Request Form). This form should be submitted with the

Hospice Election Form and the physician statement of terminal illness (see Section 16.1.1 Electing

Hospice Services).

The hospice Provider is responsible for the professional management of the individual’s hospice care,

and the nursing facility will provide room and board.

Patient contribution is allocated across claims at 100% in the order the claims are received and

processed. For example, if a Member is a resident of a nursing facility and is receiving nursing facility

hospice services in the same month, the patient contribution would be taken from the total amount

paid from the first Provider (nursing facility or hospice Provider) to bill and be paid until the patient

contribution is satisfied. If payment to the first Provider does not exhaust the Member’s patient

contribution, the remaining patient contribution will be applied to the next Provider’s paid claim. This

may mean that the Provider who billed for the Member for the second half of the month will be

collecting the patient contribution and the Provider billing for the first half of the month will receive a

zero patient contribution assignment. For subsequent months, the full patient contribution will be

applied to the hospice claim.

In both cases the Providers need to determine the order in which claims should be billed, and how the

patient contribution will be transferred between Providers. Wyoming Medicaid cannot advise Providers

how to handle this business-related transaction.

Nursing homes will receive pro-rated patient contribution letters; however, these are not for billing

purposes.

If a claims adjustment is submitted with a pro-rated patient contribution letter, the adjustment will be

returned.

The nursing home will not be able to submit any claims for a Member who has elected hospice care.

(see Section 18.3 Members Under Hospice Care).