Provider Notice issued 10/10/08

Rate Changes Effective October 1, 2008    

The Centers for Medicare and Medicaid Services (CMS) recently notified the department of the annual update of Medicaid hospice rates for federal fiscal year 2009. Medicaid hospice rates are calculated based on the annual hospice rates established under Medicare. These rates are authorized by Section 1814(i)(1)(C)(ii) of the Social Security Act, which also provides for an annual increase in payment rates for hospice care services. Revised rates will be effective for claims with dates of service from October 1, 2008, through September 30, 2009.

The annual hospice rate update is posted to the department’s Web site at <http://www.illinois.gov/hfs/MedicalProviders/MedicaidReimbursement/Pages/default.aspx>. This site provides the following information:

• A table identifying each Illinois county and its assigned Core-Based Statistical Area (CBSA), and corresponding wage index.

• Revised rate components (wage component and unweighted amount) to be used in the calculation of rates for all four types of hospice care.

• The formulas for calculating all four types of hospice care payments, and examples.

Payment for all types of hospice care is based upon the geographic location (CBSA) where the service is furnished.

• Hospice providers must use Value Code 61 with the appropriate CBSA on their claims to identify the location where the Routine Home Care (Revenue Code 651) or Continuous Home Care (Revenue Code 652) services were provided. The CBSA must be placed right justified to the left of the dollar/cents delimiter. If the patient resided in more than one CBSA during a billing period, the last CBSA should be reported on the claim for payment. If more than one Value Code 61 is reported on the claim, the claim will reject.

• Hospice providers must use Value Code G8 with the appropriate CBSA to identify where the inpatient facility is located to report on claims containing Inpatient Respite Care (Revenue Code 655) or General Inpatient Care (Revenue Code 656). The CBSA must be placed right justified to the left of the dollar/cents delimiter. If multiple inpatient locations with differing CBSAs are used in a billing period, the last CBSA should be reported on the claim for payment. If more than one Value Code G8 is reported on the claim, the claim will reject.

If a hospice provider needs to bill a CBSA that is not identified on the Web site table, please contact the hospice's billing consultant at the department. The department will need to add the CBSA to the department’s database in order for the claim to process correctly.

The department encourages providers to register to receive e-mail notification when the department posts new provider information. Providers may register at the following HFS Web site: http://www.hfs.illinois.gov/provrel

If you have any questions concerning this notice, please contact your billing consultant in the Bureau of Comprehensive Health Services toll-free at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs