DADS has replaced April 29, 2005, hospice and nursing facility Provider Letter 05-20 with Long Term Care (LTC) Provider Letter No. 06-07 in order to emphasize that Medicaid hospice providers will not be paid for services unless the hospice provider already has its contract and Medicaid number. The bottom line is that…
If licensed and certified hospice providers provide hospice services to an individual in a NF without a Medicaid hospice contract, the hospice will not be paid.
Providers became confused about the meaning of the prior April 29, 2005 letter. Some interpreted it to mean that the Nursing Facility should continue to pay, in anticipation of reimbursement, for hospice services provided by a hospice provider who had applied for licensure and the contract, and was merely awaiting the contract and the assignment of a Medicaid provider number. This interpretation was incorrect and may have created some billing conflicts between hospice providers and nursing facilities.
To be paid, a Hospice provider must fulfill the following requirements::
1. The hospice has a Medicaid hospice contract with DADS. DADS suggests that a copy of the Medicaid contract be shared with the NF.
2. The individual elects the Medicaid hospice benefit. DADS will not accept a Medicaid hospice election that is effective before the hospice has a valid Medicaid hospice contract. An individual cannot successfully choose a hospice provider that is not part of the Medicaid program.
3. To receive payment for services, Medicaid hospice providers must submit Medicaid hospice eligibility forms: Medicaid Hospice Election Form 3071, and Medicaid Hospice Physician Certification for Terminal Illness Form 3074, to Provider Claims Services to initiate payment for services. The forms must not be signed by an individual or submitted to Provider Claims Services until the hospice provider has a fully executed Medicaid hospice contract with DADS. Any forms received by DADS from hospice providers without a fully executed Medicaid hospice contract will be returned to the hospice provider and neither hospice per diem nor room-and-board payments will be made.