Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 31 - SERVICES IN AN INTERMEDIATE CARE FACILITY FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES (ICF/DD)
Section 471-31-007 - HOSPICE SERVICES
Universal Citation: 471 NE Admin Rules and Regs ch 31 ยง 007
Current through March 20, 2024
007.01 DEFINITION OF HOSPICE. Hospice or hospice services must meet the definition outlined in 471 NAC 36.
007.02 STANDARDS FOR PARTICIPATION. To participate in Medicaid, a hospice must be a public agency or private organization, or a subdivision of either, primarily engaged in providing care to terminally ill individuals and is certified for participation in Medicare as a hospice.
007.02(A)
PROVIDER
ENROLLMENT. To complete the provider enrollment process for adult
clients, the hospice must meet the following conditions:
(i) The hospice must have a signed, written,
non-resident-specific contract with the intermediate care facility for
individuals with developmental disabilities (ICF/DD): and
(ii) The hospice must complete and submit a
Nebraska Medicaid provider agreement in its entirety to Medicaid for each
contracted intermediate care facility for individuals with developmental
disabilities (ICF/DD).
007.03 PRIOR AUTHORIZATION PROCESS. The following must be completed before Medicaid authorizes payment to the hospice for board and room:
(A) The hospice must request prior
authorization for payment by paper or electronically, if requesting prior
authorization by paper, the hospice must provide Medicaid all records listed
below:
(i) Form MC-9NF, or Nursing Facility
Level of Care Determination Form;
(ii) Physician's order for hospice services,
including rationale for the need of hospice services including certification of
terminal illness;
(iii) Hospice
plan of care, including the responsibilities of the intermediate care facility
for individuals with developmental disabilities (ICF/DD) as part of the hospice
services:
(iv) List of hospice
covered medications and pharmacy notification;
(v) List of hospice covered medical
appliances, supplies, and therapies: and
(vi) The hospice must obtain prior
authorization for the actual hospice service when Medicaid is the primary
payer.
007.04 BILLING AND PAYMENT FOR HOSPICE BOARD AND ROOM.
007.04(A)
BILLING.
Hospice providers must bill Medicaid on the appropriate claim form or
electronic format.
007.04(B)
PAYMENT OF BOARD AND ROOM TO THE HOSPICE PROVIDER.
Medicaid pays the hospice for the client's board and room in the intermediate
care facility for individuals with developmental disabilities (ICF/DD) facility
when the following conditions are met:
(1)
The hospice and the facility must have a written agreement under which the
hospice is responsible for the professional management of the client's hospice
care;
(2) The client must be
eligible for Medicaid benefits:
(3)
The client must have elected to receive the Medicare or Medicaid hospice
benefit:
(4) The client must reside
in a Medicaid-certified bed in the intermediate care facility for individuals
with developmental disabilities (ICF/DD) facility;
(5) The client's medical needs must meet the
Medicaid criteria and be approved for intermediate care facility for
individuals with developmental disabilities (ICF/DD) level of care;
(6) Prior authorization requirements must be
met; and
(7) The client is an
adult.
007.04(B)(i)
FACILITY AND HOSPICE CONTRACT. The hospice must make
payment to the intermediate care facility for individuals with developmental
disabilities (ICF/DD) facility for the client's board and room according to the
contract between the facility and the hospice,
007.04(B)(ii)
PER DIEM
LIMITATIQN. The provider must not bill Medicaid for any provider
service related to the terminal illness that is included in the Medicare
hospice benefit or services covered under the Medicaid intermediate care
facility for individuals with developmental disabilities (ICF/DD) per diem.
007.04(B)(iii)
CHILD
LIMITATION. Nebraska Medicaid does not pay the hospice for the
client's board and room expense in the intermediate care facility for
individuals with developmental disabilities (ICF/DD) if the client is a
child.
Disclaimer: These regulations may not be the most recent version. Nebraska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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