Hospice: Inpatient Payment Limitations

If the Department determines an inpatient rate should not be paid, any days a provider receives payment at a home care rate is not counted as inpatient days. Limitations include: (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 658 Page 160 01. Maximum Allowable Inpatient Days. Calculated by multiplying the total number of a provider’s Medicaid hospice days by twenty percent (20%). If the total amount exceeds the maximum number of allowable inpatient days, a payment limitation is determined by: (7-1-26) a. Calculating the ratio of the maximum allowable inpatient days to the number of actual inpatient care days and multiplying the ratio by the total payment for inpatient care made. (7-1-26) b. Multiplying excess inpatient care days by the routine home care rate. (7-1-26) c. Adding the two (2) calculated amounts and comparing the sum to interim inpatient hospice care payments made during the “cap period.” (7-1-26) 02. Limitation Cap. When any interim payments for inpatient care exceed the limitation, a provider must return the amount over the limitation. (7-1-26)