HAR §17-1737-107. Payment for hospice care

(a) Payments shall be available to Medicaid providers certified by Medicare to render hospice care as provided for under this subchapter. (b) Payment for hospice care shall be made using the same methodology as Medicare and in the amounts specified by CMS. (c) Payment for services or items not related to the terminal illness and billed by other Medicaid non- hospice providers are allowed. (d) For a Medicaid recipient who resides in a nursing facility and meets the nursing facility level of care requirements, but elects hospice, the Medicaid program will pay the hospice provider: (1) For routine hospice services; and (2) Ninety-five percent of the facility specific per diem rate for ICF services. The Medicaid program shall not pay the NF. (e) The following categories shall be utilized to determine payment: UNOFFICIAL 1737-113 (1) Routine home care day. A routine home care day is a day on which an individual who has elected to receive hospice care is at home and is not receiving continuous care as defined in paragraph (2); (2) Continuous home care day. A continuous home care day is a day on which an individual who has elected to receive hospice care is not in an inpatient facility and receives hospice care consisting predominantly of nursing care on a continuous basis at home. Home health aide or homemaker services or both may also be provided on a continuous basis. Continuous home care is furnished during periods of crisis and only as necessary to maintain the terminally ill patient at home. A minimum of eight hours of care shall be required to qualify for the continuous home care rate; (3) Inpatient respite care day. An inpatient respite care day is a day on which the individual who has elected hospice care receives care in an approved facility on a short-term basis for respite. Respite care may not be reimbursed for more than five consecutive days at a time; and (4) General inpatient care day. A general inpatient care day is a day on which an individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings. [Eff 08/01/94; am 02/07/05] (Auth: HRS §§346-14, 346-59) (Imp: 42 U.S.C. §1396(a) and (d); HRS §346-59)