DAR File No. 37656

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-14A-26

Payment for Nursing Facility, ICF/ID, and Freestanding Inpatient Hospice Unit Room and Board

Notice of Proposed Rule

(Amendment)

DAR File No.: 37656
Filed: 05/22/2013 03:16:53 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This change is necessary to comply with the mandate for concurrent care as found in the Patient Protection and Affordable Care Act. This change will promote the ability for children to receive true concurrent care rather than having to make a choice between hospice care and skilled care in a facility.

Summary of the rule or change:

This amendment updates the Medicaid Hospice program to reflect the hospice room and board payment rate at 100% of the amount a child would have received in a skilled nursing facility or an intermediate care facility for persons with intellectual disabilities (ICF/ID).

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• Section 26-1-5

Anticipated cost or savings to:

the state budget:

Based on an estimate of four children who would elect to receive concurrent hospice care and skilled facility care for one year, the Department anticipates a cost to the General Fund of about $16,000 and a cost in federal funds of about $36,600.

local governments:

There is no impact to local governments because they neither fund the Medicaid Hospice program nor provide hospice care services to Medicaid clients.

small businesses:

Small businesses will share some of the total annual revenue noted below for other persons or entities.

persons other than small businesses, businesses, or local governmental entities:

Hospice care providers may see an increase in total annual revenue of about $52,600 as a result of this change. Further, Medicaid clients who elect to receive concurrent hospice care and skilled facility care will see out-of-pocket savings based on this total amount.

Compliance costs for affected persons:

There are no compliance costs because this amendment can only result in an increase in revenue to a hospice care provider, and can only result in out-of-pocket savings to a Medicaid client who elects to receive both concurrent hospice care and skilled facility care.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule will provide slight increases in reimbursement to providers in long term care facilities and ICFs.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at [email protected]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

07/15/2013

This rule may become effective on:

07/22/2013

Authorized by:

David Patton, Executive Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-14A. Hospice Care.

R414-14A-26. Payment for Nursing Facility, ICF/ID, and Freestanding Inpatient Hospice Unit Room and Board.

(1) For clients in a nursing facility, ICF/ID, or a freestanding hospice inpatient unit who elect to receive hospice care from a Medicaid enrolled hospice provider, Medicaid will pay the hospice provider an additional per diem for routine home care services to cover the cost of room and board in the facility. For nursing facilities and ICFs/ID, the room and board rate is 95 % of the amount that the Department would have paid to the nursing facility or ICF/ID provider for that client if the client had not elected to receive hospice care. For freestanding hospice inpatient facilities, the room and board rate is 95% of the statewide average paid by Medicaid for nursing facility services.

(a) For clients under 21 years of age, the room and board rate is 100% of the amount that the Department would have paid to the nursing facility or ICF/ID for that client if the client had not elected to receive hospice care.

(2) The Department shall reimburse the hospice provider for room and board. Upon receiving payment for room and board, the hospice provider shall reimburse the nursing facility. The reimbursement is payment in full for the services described in Section R414-14A-15. The facility cannot bill Medicaid separately.

(3) If a hospice enrollee in a nursing facility, ICF/ID, or a freestanding hospice inpatient unit has a monetary obligation to contribute to his cost of care in the facility, the facility must collect and retain the contribution. The hospice must reimburse the facility the reduced amount received from Medicaid directly or from a Medicaid Health Plan.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [February 1, 2012]2013

Notice of Continuation: September 30, 2009

Authorizing, and Implemented or Interpreted Law: 26-1-4.1; 26-1-5; 26-18-3