Date: October 13, 2020
To: Enrolled Hospice Agencies
Re: Nursing Facility Rate Changes Affecting Hospice Patient Room and Board Payment
This notice informs hospices of recent nursing facility rate changes that impact payment for hospice patient nursing home room and board.
Nursing facility rates have been revised effective for dates of service beginning July 1, 2020. The rates have been posted to the HFS website and provided to the Managed Care plans, with the expectation that the plans begin to pay at the updated rates effective for dates of service beginning July 1, 2020. However, the Department is awaiting approval from the federal Centers for Medicare and Medicaid Services (CMS) to begin fee-for-service reimbursement at the revised rates. Until approved, HFS will not utilize the new rates when pricing the fee-for-service claims. Payment continues at the nursing facility rates in effect as of June 30, 2020.
Hospices should be aware that room and board charges billed in this interim period for fee-for-service participants will be paid at the old rates. The Department will not initiate adjustments for any hospice claims that have already been adjudicated and paid at the old rates. It will be the hospice’s responsibility to void and rebill claims if necessary.
As nursing facility rates are periodically changed, future adjustments for nursing home room and board payments will continue to be the responsibility of the hospice if required by the contracts with its nursing facility partners.
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