Current through Register Vol. 48, No. 39, March 25, 2024
Subpart 1.
Rate categories.
Providers of hospice care as described in part
9505.0297 are paid at one of four
fixed daily rates that apply to each of the four categories of services in
subpart
3. The fixed daily rates
apply to all services, except for certain physician services as described in
subpart
5, and room and board in a
long-term care facility as described in subparts
6 and
7.
Subp. 2.
Long-term care facility as
residence.
For purposes of this part, a recipient who resides in a
long-term care facility is considered to live at home.
Subp. 3.
Categories of service.
Except as otherwise provided by subparts
4 to
6, no payments shall be made
for specific services provided by the hospice. Fixed daily rates are calculated
under subpart
4 for each of the following
categories of services:
A. Routine
home care day, which is a day on which a recipient who has elected to receive
hospice care is at home and is not receiving continuous care as defined in item
B.
B. Continuous home care day,
which is a day on which a recipient who has elected to receive hospice care has
not been admitted to a facility that provides inpatient care, except when a
long-term care facility is the recipient's residence under subpart
2, and the recipient receives
hospice care consisting of nursing services, including home health aide or
homemaker services, on a continuous basis at home, as provided by part
9505.0297, subpart 17. No fewer
than eight hours a day of nursing care must be provided by a registered nurse
or licensed practical nurse. Continuous home care may be furnished only during
periods of crisis as described in part
9505.0297, subpart 17, and only as
necessary to maintain the terminally ill recipient at home.
C. Inpatient respite care day, which is a day
on which the recipient who has elected hospice care receives inpatient care in
an inpatient facility certified for medical assistance on a short-term basis
for respite. This item is subject to the limits provided by part
9505.0297, subpart 18. This item
does not apply to a recipient whose residence is a long-term care facility
under subpart
2.
D. General inpatient care day, which is a day
on which a recipient who has elected hospice care receives general inpatient
care in a hospital or skilled nursing facility that provides inpatient care for
control of pain or management of acute or chronic symptoms that cannot be
managed in other settings. This item does not apply to a recipient who receives
inpatient care in a long-term care facility in which the recipient is a
resident under subpart
2.
Subp. 4.
Payments and
limitations.
Medical assistance will pay a hospice for each day a
recipient is under the hospice's care. Payment is in the same amounts, uses the
same methodology, and is subject to the same limits and cap amount used by
Medicare under Code of Federal Regulations, title 42, sections 418.301 to
418.309, as amended through October 1, 1987, except that the inpatient day
limit on both inpatient respite care days and general inpatient care days does
not apply to recipients afflicted with acquired immunodeficiency syndrome
(AIDS), as provided by United States Code, title 42, section 1396d(o)(1)(B).
The rates are determined by the Centers for Medicare and Medicaid Services
(CMS), United States Department of Health and Human Services, as provided by
Code of Federal Regulations, title 42, section 418.306, as amended through
October 1, 1987, and as adjusted by CMS for the Medicare copay amounts not
allowed under medical assistance. Payments to long-term care facilities under
subparts
6 and
7 are not included in the cap
amount. Changes in rates are announced in the Federal Register. No payment will
be made for bereavement counseling under part
9505.0297, subpart 19.
Subp. 5.
Payment for
physician services.
Physician services are paid according to items A to C.
A. The services specified in subitems (1) and
(2) are included in the rates provided by subpart
4:
(1) general supervisory services of the
hospice's medical director; and
(2)
participation in the establishment of plans of care, supervision of care and
services, periodic review and updating of plans of care, and establishment of
governing policies by the physician member of the hospice's interdisciplinary
group.
B. Other than for
services described in item A, medical assistance shall pay the hospice for
physician services furnished by physicians who are employees of the hospice or
who provide services under arrangements with the hospice, at the rate provided
by part
9505.0445, item E. Payment for
these physician services is included in the amount subject to the cap amount in
subpart
4. No payment will be made to
the hospice for services donated by physicians who are employees of the hospice
or who provide services under arrangements with the hospice.
C. Services of the recipient's attending
physician, if the physician is not an employee of the hospice or is not
providing services under arrangements with the hospice, are not considered
hospice services and are not included in the amount subject to the cap amount
in subpart
4. These services are
reimbursed according to parts
9505.0345 and
9505.0445, item E.
Subp. 6.
Payment for room
and board in long-term care facilities.
If a recipient resides in a long-term care facility under
subpart
2 that is certified as a
medical assistance provider and the recipient has elected medical assistance
coverage of hospice services, the long-term care facility shall not be paid by
medical assistance under parts
9549.0010 to
9549.0080, but shall be paid by
the hospice at a rate negotiated by the long-term care facility and the
hospice.
Subp. 7.
Payment to hospice for residents of long-term care facilities.
The commissioner shall establish the payments to hospices for
the room and board of medical assistance recipients who reside in long-term
care facilities certified by medical assistance, as provided by items A and
B.
A. The daily room and board payment
rate shall be either:
(1) 83 percent of the
long-term care facility's daily payment rate for the recipient's resident
class, as determined under parts
9549.0010 to
9549.0080; or
(2) 83 percent of the long-term care
facility's daily payment rate for the recipient's certification level, if the
long-term care facility is not subject to parts
9549.0010 to
9549.0080.
B. The payment to the hospice is the product
of the hospice's daily room and board payment rate determined in item A and the
number of days for which the recipient resides in the long-term care facility
in the month, less the recipient's spend down amount for that month under part
9505.0065, subpart 11, item
F.
Statutory Authority: MS s
256B.02