New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-W - Former Division of Human Services
Chapter He-W 500 - MEDICAL ASSISTANCE
Part He-W 544 - HOSPICE SERVICES
Section He-W 544.13 - Payment for Hospice Services

Universal Citation: NH Admin Rules He-W 544.13

Current through Register No. 40, October 3, 2024

(a) Hospice providers shall submit claims for payment to the department's fiscal agent.

(b) Payment for hospice care, with the exception of physician services which are paid in accordance with He-W 544.16, shall be at a per diem rate for each day that the recipient is under the care of the hospice provider.

(c) The per diem rate shall:

(1) Be determined in accordance with medicare regulations at 42 CFR 418, Subpart G;

(2) For continuous home care, be calculated based upon the number of hours of continuous home care furnished to arrive at a per diem rate, in accordance with 42 CFR 418.302(e) (4) ; and

(3) Be based upon the level of care as follows:
a. Routine home care;

b. Continuous home care;

c. Inpatient respite care; and

d. General inpatient care.

(d) Payment for inpatient respite care shall be limited to one period of no more than 5 consecutive days in each election period.

(e) Inpatient respite care provided in excess of the 5 day limit per election period shall be paid at the routine home care rate.

(f) If there is a change in designated provider, admission status, or level of care, payment shall be made as follows:

(1) If admission occurs on the same day as discharge, revocation or death, the day shall be considered a hospice care day and the hospice shall be paid in accordance with (c) above;

(2) If the level of care changes, payment shall be made for the new level of care beginning with the day it commences;

(3) If a change of hospice provider occurs, payment shall not be made to the discharging hospice for the day of discharge, but payment shall be made to the newly designated hospice; and

(4) If the recipient is discharged from an inpatient unit, the routine home care rate shall be paid, unless the recipient dies as an inpatient, in which case the general inpatient or respite care rate shall be paid for the discharge date.

(g) If certification is not obtained in accordance with the provisions of He-W 544.06(a) -(c) , payment shall not be made for days prior to certification.

(h) Bereavement counseling pursuant to He-W 544.09(c) shall not be billable to Title XIX nor to the recipient's family pursuant to He-W 544.09(d) .

#9726-A, eff 7-1-10

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