Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1130 - HOSPICE SERVICES
PAYMENT FOR HOSPICE CARE
Section 1130.71 - General payment policy
Current through Register Vol. 54, No. 12, March 23, 2024
(a) Payment is made to a participating hospice in accordance with the coverage and payment rates established by Medicare regulations at 42 CFR 418.302 (relating to payment procedures for hospice care). Exceptions are as follows:
(b) Payment is made to the hospice for each day during which the recipient is eligible and under the care of the hospice, regardless of the amount of services furnished on a given day.
(c) Payment is not made for days not covered by a valid certification of terminal illness.
(d) Payment for inpatient respite care is limited to no more than a total of 5 days in a 60-day certification period. Payment for inpatient respite care days in excess of the limit will be made at the routine home care rate.
(e) Payment is not made for general inpatient care if the Department determines that a lesser level of care was actually provided.
(f) No MA payments will be made directly to a nursing facility for services provided to a recipient who is under the care of a hospice.
(g) Ambulance transportation related to management of the recipient's terminal illness is included in the daily rates. A separate payment will not be made to the hospice provider or to an ambulance provider for this service.
(h) The Department will reduce its payment for hospice care by the amount of income available from the recipient towards the hospice care rate established by the Department.