DOH Webinar on Hospice Carve-in to Medicaid Managed Care

The following information has been provided by LeadingAge New York's legislative, regulatory and legal counsel, Hinman Straub:

"Last Wednesday, the Department of Health hosted a Webinar for Medicaid Managed Care (MMC) plans to discuss the carve-in to MMC of the hospice benefit, scheduled for October 1, 2013. Along with the carve-in, DOH announced that they are pursuing a change in the hospice benefit with CMS to expand eligibility to individuals with life expectancies up to one year (versus the current six months).

The benefit change is just for non-duals (Medicaid only) and does not apply to MLTC. Previously in MMC, the person remained in the plan but hospice was paid FFS, which is currently how the benefit operates under MLTC. As part of the transition, DOH discussed that MMC plans will be required to reimburse hospice providers at their FFS rate for the first year of the transition (October 1, 2013 – September 30, 2014). After one year, a new rate can be negotiated.

Importantly, individuals in receipt of hospice services prior to October 1 will continue to have those services covered under FFS for the duration of the services. DOH has a list of these individuals (only 195 people) which will be used by eMedNY to continue to allow the payment of hospice claims through Medicaid FFS. The list was derived from Medicaid FFS claims data; therefore, it may not include individuals admitted recently admitted to hospice. Hospice providers should contact DOH with the name and Medicaid ID # of any patients that are enrolled in a managed care plan and admitted to hospice before October 1 if they have any problems billing Medicaid FFS. Plans will be responsible for enrollees new to hospice on or after October 1.

Once carved-in, MMC plans will pay hospice providers a per diem payment rate that will cover all necessary health and palliative care services, including bereavement counseling for the family. Hospices will be responsible for case management. There are a number of outstanding items, such as whether the per diem hospice payment includes payment to reimburse nursing homes for room and board costs and whether the per diem covers Home Health Aide services. The Department expects to provide guidance on these issues in the form of a Questions and Answers document, along with a list of providers by county and rates of payment, in the next few days."

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871