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Hospice

Myers and Stauffer LC is the long-term care rate-setting contractor that sets the Indiana Health Coverage Programs (IHCP) rates for nursing facilities, hospices, home health agencies, and group homes. Hospice providers can obtain current rate information for a particular nursing facility by accessing the Myers and Stauffer long-term care website and following these steps:

  • Click Long Term Care located on the left.
  • Click Nursing Facility.
  • Click the Other Reports folder for a list of available reports.
  • From the list of reports, click Cumulative Rate Listing.
  • You will be presented with a report listing Medicaid rates for all Medicaid-certified nursing facilities. Medicaid rates are updated within 24 hours of finalization.

Reimbursement for IHCP hospice benefits is based on the methodology established by the Centers for Medicare & Medicaid Services (CMS) for the administration of the federal Medicare program, adjusted to disregard offsets attributable to Medicare coinsurance amounts. Additionally, IHCP rates are further adjusted for regional wage differences.

The annual hospice rates are effective October 1 of each year through September 30 of the following year, and are announced via IHCP Bulletins. Providers can search for the most recent announcement at the Bulletins page (search for "hospice rates").

The IHCP reimburses hospice providers for hospice services in a hospice facility, in a nursing facility, and in a private home.

Enrollment statistics historically reflect that the majority of individuals enrolled through the IHCP hospice benefit reside in nursing facilities. Hospice services provided in a nursing facility are reimbursed at 95% of the nursing facility case-mix rate on file when billing the IHCP for room and board under the hospice benefit using hospice revenue codes 653, 654, and 659. The IHCP pays the hospice provider 95% of the lowest nursing facility rate, so the hospice provider may reimburse the nursing facility according to their contract.

The CMS rule 1629-F revised reimbursement for routine home care hospice services, applying a higher per diem rate to routine home care services rendered during the first 60 days of hospice care and a reduced per diem rate to routine home care services rendered on days thereafter. These differing rates serve to capture the varying levels of resource intensity necessary during the course of providing routine home care hospice services. The rule also established a service intensity add-on (SIA) payment for face-to-face services provided by a registered nurse (RN) or social worker during the last seven days of a member's life.

Resources

For more information about IHCP hospice services, including billing guidance, forms, and contact information, see the following resources, all available on this website:

 

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