Provision of Services to Hospice Patients in an RHC or FQHC

210.2 - Provision of Services to Hospice Patients in an RHC or FQHC (Rev. 11803; Issued: 01-26-23; Effective: 01-01-23; Implementation: 02-27-23) For hospice services that are not described above in section 210.1, RHCs and FQHCs can treat hospice beneficiaries for medical conditions not related to their terminal illness. However, if a Medicare beneficiary who has elected the hospice benefit receives care from an RHC or FQHC related to his/her terminal illness, the RHC or FQHC cannot be reimbursed for the visit, even if it is a medically necessary, face-to- face visit with an RHC or FQHC practitioner, since that would result in duplicate payment for services, except under either of the following circumstances: • The RHC or FQHC has a contract with the hospice provider to furnish core hospice services related to the patient’s terminal illness and related conditions when extraordinary circumstances exist within the hospice. Extraordinary circumstances are described as “unanticipated periods of high patient loads; staffing shortages due to illness or other short-term temporary situations that interrupt patient care; and temporary travel of a patient outside the hospice’s service area” (42CFR 418.64); • The RHC or FQHC has a contract with the hospice provider to furnish highly specialized nursing services that are provided by the hospice so infrequently that it would be impractical and prohibitively expensive for the hospice to employ a practitioner to provide these services. For example, a hospice may infrequently have a pediatric patient, and in those situations, contract with an RHC or FQHC that has a pediatric nurse on staff to furnish hospice services to the patient. In these situations, all costs associated with the provision of hospice services must be carved out of the RHC or FQHC cost report, and the RHC or FQHC would be reimbursed by the hospice. (42 CFR 418.64(b)(3)). Any service provided to a hospice beneficiary by an RHC or FQHC practitioner must comply with Medicare prohibitions on commingling. (See section 100 of this chapter).