Date: September 25, 2020
To: Participating Hospice Providers
Re: Annual Rate Changes Effective October 1, 2020
The federal Centers for Medicare and Medicaid Services recently notified the Department of the annual update of Medicaid hospice rates for federal fiscal year 2020. Medicaid hospice rates are calculated based on the annual hospice rates established under Medicare. These rates are authorized by Section 1814(i)(1)(C)(ii) of the Social Security Act, which also provides for an annual increase in payment rates for hospice care services.
Revised rates for routine home care, service intensity add-on, continuous home care, inpatient respite care and general inpatient care will be effective for claims with dates of service from October 1, 2019, through September 30, 2020.
The annual hospice rate update is posted to the Department’s website. This site provides the following information:
- A table identifying the Core-Based Statistical Area (CBSA) for each Illinois county and the corresponding wage index.
- Revised rate components (wage component and unweighted amount) to be used in the calculation of rates for all types of hospice care.
- The formulas for calculating the types of hospice care payments as well as examples.
This year there are 10 instances where counties have been assigned to a different CBSA. The affected counties are bolded in the latest CBSA/Wage Index table on the hospice rate update webpage.
Payment for all types of hospice care is based upon the geographic location (CBSA) where the service is furnished.
· Hospice providers must use Value Code 61 with the appropriate CBSA on their claims to identify the location where the Routine Home Care (Revenue Code 0651) or Continuous Home Care (Revenue Code 0652) services were provided. The CBSA must be placed right justified to the left of the dollar/cents delimiter. If the patient resided in more than one CBSA during a billing period, the last CBSA should be reported on the claim for payment. If more than one Value Code 61 is reported on the claim, the claim will reject.
· Hospice providers must use Value Code G8 with the appropriate CBSA to identify where the inpatient facility is located to report on claims containing Inpatient Respite Care (Revenue Code 0655) or General Inpatient Care (Revenue Code 0656). The CBSA must be placed right justified to the left of the dollar/cents delimiter. If multiple inpatient locations with differing CBSAs are used in a billing period, the last CBSA should be reported on the claim for payment. If more than one Value Code G8 is reported on the claim, the claim will reject.
If a hospice provider needs to bill a CBSA that is not identified on the website table, please contact the hospice’s billing consultant at the Department. The Department will need to add the CBSA to the Department’s database in order for the claim to process correctly.
Questions regarding this notice may be directed to a hospice billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.
Interim Medicaid Administrator