Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-14A - Hospice Care
Section R414-14A-6 - Reimbursement

(1) Hospice agency and provider reimbursement for hospice services are made in accordance with the methodologies outlined in the Utah Medicaid State Plan.

(2) Reimbursement for services provided during a capped period is limited to the cap amount and Medicaid does not apply the aggregate caps used by Medicare.

(3) Services provided in a veteran's administration hospital or military hospital are not reimbursable.

(4) The hospice provider may request an exception to the inpatient care reimbursement limitation if the hospice provider demonstrates the volume of Medicaid enrollees during the cap period was insufficient to reasonably achieve the required 20% ratio.

(5) Direct care provided by a hospice physician, related to the terminal illness or a related condition, are separately reimbursable.

(6) Service provided by members' attending physicians are separately reimbursable.

(7) Medicaid reimbursement covers the same services and amounts covered by the equivalent Medicare reimbursement rate for comparable service categories.