Myers and Stauffer is the long-term care (LTC) rate-setting contractor that sets the Indiana Health Coverage Programs (IHCP) rates for nursing facilities, hospices, home health agencies and group homes.
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 IHCP Bulletins page (search for "hospice").
Inpatient Hospice Services
The IHCP reimburses hospice providers for general inpatient hospice services and for inpatient respite hospice services delivered in a hospice facility, hospital or skilled nursing facility (SNF). Inpatient respite hospice care may also be reimbursed when provided in a nursing facility, if the member does not usually reside in a nursing facility and is there for respite care only.
The IHCP reimburses hospice providers for inpatient respite hospice care and general inpatient hospice care at the IHCP hospice per diem only. There is no additional room and board per diem for these services.
Home Hospice Services
The IHCP reimburses hospice providers for routine home hospice care and continuous home hospice care delivered in a private home, a nursing facility or other residential setting.
Enrollment statistics historically reflect that the majority of individuals enrolled through the IHCP hospice benefit reside in nursing facilities. The routine and continuous care hospice reimbursement methodologies make a distinction between care provided in a home setting versus a nursing facility because hospice residents in an IHCP-certified nursing facility require an additional room and board per diem, which is paid directly to the hospice provider. The IHCP pays 95% of the nursing facility’s per diem for those dates of service on which the member was a resident. The hospice provider is responsible for paying the nursing facility according to their contract.
Hospice providers can find current rate information for a particular nursing facility on the Myers and Stauffer long-term care website by following these steps:
- Gain access to the Myers and Stauffer website at myersandstauffer.com.
- Click Long-Term Care to go to the Long-Term Care page.
- Under the Nursing Facility section, click the + to expand the Other Reports folder.
- Click Cumulative Rate Listing – Nursing to download a report listing Medicaid rates for all Medicaid-certified nursing facilities.
- Medicaid rates are updated within 24 hours of finalization.
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.
The IHCP also reimburses resident-specific add-ons for special care unit (SCU) and ventilator services rendered at a qualifying nursing facility. When applicable, hospice providers should bill the IHCP for these add-ons along with the applicable room-and-board revenue code. The hospice provider will receive 100% of the reimbursement that the nursing facility would have received for the add-on payment, and the hospice must then pass on this amount to the nursing facility. A list of nursing facilities that qualify as special facilities eligible to receive these resident-specific add-ons is posted on the Myers and Stauffer website (under Nursing Facility > Schedule Z (SCU and Vent) Approved Provider Listing).
Resources
For more information about IHCP hospice services, including billing guidance, forms and contact information, see the following resources, all available on this website:
- Hospice Services provider reference module
- Hospice Forms
- Hospice Contacts
- IHCP Bulletins