IHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT OCTOBER 12, 2010
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1 IHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT OCTOBER 12, 2010 Annual hospice rates effective October 1, 2010 Each year on October 1, the Centers for Medi & Medicaid Services (CMS) releases new hospice rates to State Medicaid agencies for Medicaid-enrolled hospice providers. This bulletin provides the following information for the Indiana Health Coverage Programs (IHCP) hospice rates that are effective October 1, 2010, through September 30, 2011: A brief explanation of the method of calculation used by Myers and Stauffer, LC, the IHCP long-term contractor, about the new IHCP hospice rates. A list of the new IHCP hospice rates, effective October 1, 2010, as prepared by Myers and Stauffer. Method of calculation Reimbursement for the IHCP hospice benefit follows the methodology and level established by the CMS for the administration of the federal Medi program. Therefore, the IHCP hospice rates, based on Medi reimbursement rates and methodology, are adjusted to disregard offsets resulting from Medi premium amounts. The rates are adjusted in wages using listings from the CMS. The total per diem amounts reimbursed to an IHCP-enrolled provider are calculated according to the IHCP hospice member s location of. Hospice providers are reimbursed at one of the hospice levels of (LOC). The bullets below show how a member s hospice LOC is covered in one of the following situations: Hospice level of coverage hospice LOC in the private IHCP hospice per diem only hospice LOC in the nursing IHCP hospice per diem plus room and board per diem Continue
2 hospice LOC in the private IHCP hospice per diem only hospice LOC in the nursing IHCP hospice per diem plus room and board per diem for the private members or nursing facility members IHCP hospice per diem only. There is no additional room and board per diem for this service. for the private members or nursing facility members IHCP hospice per diem only. There is no additional room and board per diem for this service. Hospice providers are reminded that the Balanced Budget Act (BBA) of 1997 changed the reimbursement methodology so the hospice per diem for routine and continuous hospice LOC is paid using the wage- listing of the city or county where the member resides. The BBA of 1997 did specify that when a hospice bills for hospice that the hospice rate would continue to be paid using the wage listing of the city or county where the hospice is located. IndianaAIM pays IHCP hospice claims consistent with the BBA of Payment of hospice claims The Medicaid hospice payment rates for and services provided from October 1, 2010, through September 30, 2011, are as follows: Table 1 Medicaid hospice payment rates for and services Description Daily Rate Wage Component Subject to Index Unweighted Amount $ $ $45.94 $ full rate = 24. of /$35.67 $ $ $ $86.42 $73.23 $ $ $ The Daily Rate is the sum of the Wage Component Subject to Index and the Unweighted Amount. The Wage Component Subject to Index is the labor portion of the Daily Rate. The Unweighted Amount is the nonlabor portion of the Daily Rate. The Hospice Wage Adjusted Rates are computed by multiplying the Wage Component Subject to Index by the wage for the applicable geographic area and adding the result to the Unweighted Amount.
3 Medicaid hospice rates effective October 1, 2010 Hospice Wage-Adjusted Rates Effective October 1, 2010 name Anderson: Madison Bloomington: Greene Monroe Owen Cincinnati: Dearborn Ohio Franklin Columbus: Bartholomew Elkhart-Goshen: Elkhart Evansville: Gibson Posey Vanderburgh Warrick Fort Wayne: Allen Wells Whitley Gary: Lake Jasper Newton Porter Indianapolis: Boone Brown
4 name Hamilton Hancock Hendricks Johnson Marion Morgan Putnam Shelby Kokomo: Howard Tipton Lafayette: Benton Carroll Tippecanoe Louisville: Clark Floyd Harrison Washington Michigan City/ LaPorte: La Porte Muncie: Delaware South Bend: St. Joseph Terre Haute: Clay Sullivan Vermillion Vigo
5 name Nonurban Areas: Adams Blackford Cass Clinton Crawford Daviess De Kalb Decatur Dubois Fayette Fountain Fulton Grant Henry Huntington Jackson Jay Jefferson Jennings Knox Kosciusko Lagrange Lawrence Marshall Martin Miami Montgomery Noble Orange Parke Perry Pike Pulaski Randolph Ripley Rush Scott Spencer Starke Steuben Switzerland Union Wabash
6 name Warren Wayne White The Hospice Wage Index was published in the Federal Register July 22, States adjust the wage component of the daily hospice payment rates to reflect local geographical differences in the wage levels. Questions? If you have questions about this bulletin, please contact Customer Assistance at (317) in the Indianapolis local area or toll-free at Copies of this bulletin If you need additional copies of this bulletin, please download them from the IHCP Web site. To receive notifications of future IHCP publications, subscribe to the IHCP Notifications.
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