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Provider Notice Issued 09/20/2018
Date: September 20, 2018
To: Participating Hospice Agencies
Re: Hospice Coverage in Managed Care Plans
The purpose of this notice is to affirm that the Medicaid hospice benefit is available under all HealthChoice Illinois managed care plans.
Hospice care is a covered benefit under the Illinois Medicaid State Plan. The Centers for Medicare and Medicaid Services (CMS) establishes payment amounts for the following specific categories of covered hospice care: routine home care, continuous home care, service intensity add-on, inpatient respite care and general inpatient care. The Department establishes payment amounts for nursing home room and board (for those hospice patients residing in a long term care facility) and physician services.
Participants who are enrolled in managed care plans are eligible to receive these services in the same manner as participants who are enrolled in Medicaid fee-for-service. If managed care plans have contracted to pay at Department rates, then reimbursement will be at the same rates as Medicaid fee-for-service, including the high/low routine home care rate structure (first 60 days of care paid at higher rate, day 61 forward at lower rate) and the service intensity add-on payment available for care provided during the last seven days of life.
The Department’s two provider notices specifically regarding the high/low routine home care payments and the service intensity add-on payment are linked below. All Department provider notices are posted to the Provider Notices webpage for reference.
Questions related to a claim for a managed care plan participant should be directed to the individual plan. Please refer to the Department’s Care Coordination webpage for managed care plan contact information.
Teresa T. Hursey
Medicaid Director