A. A hospice provider must obtain written
certification/recertification of terminal illness before billing for hospice
services.
B. The Division of
Medicaid reimburses hospice providers at one (1) of the four (4) following
predetermined rates for each day that the beneficiary is under the care of the
hospice based on the level of care required to meet the beneficiary's and
family's needs:
1. Routine Home Care (RHC):
a) Is reimbursed for each day the beneficiary
is under the care of the hospice provider and not receiving one of the other
categories of hospice care. This rate is reimbursed without regard to the
volume or intensity of routine home care services provided on any given day,
and is also reimbursed when the beneficiary is receiving outpatient hospital
care for a condition unrelated to the terminal condition.
b) Beginning January 1, 2016 is reimbursed:
1) At a higher payment rate for the first
sixty (60) days of hospice care, and
2) At a reduced payment rate for hospice care
for sixty-one (61) days and over, and
c) Includes a service intensity add-on (SAI)
payment in addition to the perdiem RHC rate for the actual direct patient care
hours provided by a registered nurse (RN) or social worker, up to four (4)
hours total per day, during the last seven (7) days of a beneficiary's life
when discharged due to death. The SAI payment is equal to the continuous home
care hourly payment rate multiplied by the amount of direct care actually
provided by an RN and/or social worker.
2. Continuous Home Care:
a) Is reimbursed only during a period of
crisis, defined as a period in which the beneficiary requires continuous care
to achieve palliation and management of acute medical symptoms, and only as
necessary to maintain the terminally ill beneficiary at home.
b) Must be a minimum of eight (8) aggregate
hours of predominantly nursing care during a twenty-four (24) hour day, which
begins and ends at midnight, and:
1) Nursing
care must be provided for more than half of the period of care, and
2) Must be provided by a registered
nurse.
c) Is reimbursed
at the hourly rate up to twenty-four (24) hours per day.
d) Is not reimbursed during a hospital,
long-term care facility, or inpatient free-standing hospice facility
stay.
3. Inpatient
Respite Care:
a) Is reimbursed on any day on
which the beneficiary is an inpatient in an approved facility for inpatient
respite care.
b) Is limited to a
maximum of five (5) consecutive days at a time.
c) Is not reimbursed when the hospice
beneficiary is a long-term care facility resident, assisted living (AL) waiver
participant, or an inpatient of a free-standing hospice.
4. General Inpatient Care:
a) Is reimbursed at the general inpatient
care rate for each day such care is consistent with the beneficiary's plan of
care.
b) Is reimbursed on any day
on which the beneficiary is an inpatient in an approved facility for general
inpatient care.
c) Is reimbursed at
the general inpatient care rate for the date of admission and all subsequent
inpatient days, except the day on which the beneficiary is
discharged.
C.
The Division of Medicaid reimburses the hospice for respite and general
inpatient days. The hospice must reimburse the facility that provides respite
inpatient care.
D. The Division of
Medicaid does not reimburse for the date of discharge or the date of
death.
E. Payment for physician
services provided in conjunction with the hospice benefit is based on the type
of service performed.
F. Payment
for physicians' administrative and general supervisory activities is included
in the hospice payment rates which include:
1. Participating in the establishment, review
and updating of plans of care,
2.
Supervising care and services, and
3. Establishing governing
policies.
G. The Division
of Medicaid reimburses the hospice provider for beneficiaries in a long-term
care facility at ninety-five percent (95%) of the long-term care facility's
Medicaid per-diem rate.
1. If the hospice
provider fails to submit the required documentation to the UM/QIO within five
(5) calendar days of the hospice election, the effective date will be the date
when the completed documentation is received.
a) The Division of Medicaid will not
reimburse the hospice or nursing facility providers for days prior to the
effective date of the election statement.
b) The hospice and/or nursing facility cannot
seek payment from the beneficiary.
2. The Division of Medicaid does not
reimburse the hospice provider for long-term care bed-hold days.
H. Hospice providers must report
all diagnoses identified in the initial and comprehensive assessments on
hospice claims, whether related or unrelated to the terminal prognosis of the
individual.
I. The Division of
Medicaid reimburses drugs not related to the beneficiary's terminal illness or
related conditions to the dispensing pharmacy through the Medicaid Pharmacy
Program.
J. The Division of
Medicaid reimburses disease specific drugs as well as other drugs related to
the palliation and management of the beneficiary's terminal illness and related
conditions in the hospice per diem rates and are not be reimbursed through the
Medicaid Pharmacy Program.
Miss. Code
Ann. §
43-13-121.
