SPECIAL BULLETIN COVID-19 #100: Hospice Provider COVID-19 Rate Structure Clarifications

Monday, June 15, 2020

NC Medicaid has implemented COVID-19 rate increase functionality to reimburse hospice care provided in a skilled nursing facility (SNF) designated as a “SNF COVID-Outbreak site” or “SNF COVID-Response site” in a ratio consistent with how hospice care is reimbursed in all other SNFs. 

This bulletin clarifies the relationship between the recently implemented targeted rate increases for SNF Outbreak and Response sites and the increased rates for any associated hospice care.

Background 

In April 2020, all hospice providers received a 5% increase to all rates, excluding room and board revenue codes, effective March 10, 2020. All SNFs also received a 5% rate increase effective March 10, 2020. Note that these increases did not change the traditional reimbursement rate relationship between SNF and hospice providers; hospice providers continued to be reimbursed at 95% of the applicable SNF base rate for hospice room and board services provided within the SNF. 

Hospice Providers Working with a SNF Not Designated as a COVID-Outbreak or COVID-Response Site

Hospice providers must continue following established billing guidelines. Doing so will ensure that the hospice providers continue to be reimbursed at 95% of the rate for the SNF in which they are providing service.

Hospice Providers Working with a SNF Designated as a COVID-Outbreak or COVID-Response Site

Hospice providers must follow the targeted rate increase requirements outlined below to be reimbursed at 95% of the rate for these SNFs.

Hospice Care Rates in SNF COVID-Outbreak and COVID-Response Sites

SNFs are eligible to bill one of two temporary COVD-19 rates once they have been confirmed to be either a SNF COVID-Outbreak site or a SNF COVID-Response site (see ”SPECIAL BULLETIN COVID-19 #82: Expedited Hardship Advances and Retroactive Targeted Rate Increases for Skilled Nursing Facilities and Adult Care Homes Serving COVID-positive Patients” for details regarding these sites). 

Note: Hospice room and board services provided in these specially designated facilities are eligible to bill 95% of the temporary COVID-19 SNF rates by following the reimbursement guidelines below. 

Non-COVID+ Resident Rate in a SNF COVID-Outbreak or COVID-Response Site 

  • Each SNF COVID-Outbreak or COVID-Response site may bill its assigned Non-COVID+ resident base rate for residents who are not COVID+ while receiving care in a SNF COVID-Outbreak or COVID-Response site. 
  • Hospice providers will be reimbursed at 95% of the SNF’s Non-COVID+ resident base rate for room and board services provided to a Non-COVID+ hospice resident in a SNF COVID-Outbreak or COVID-Response site.
  • Hospice claims submissions must follow standard billing guidelines to receive 95% of the applicable SNF assigned rate.

COVID+ Resident Rate in a SNF COVID-Outbreak or COVID-Response Site

  • Each SNF COVID-Outbreak or COVID-Response site may bill its assigned COVID+ resident base rate for all residents that are COVID+ while receiving care in a SNF COVID-Outbreak or SNF COVID-Response site.
  • Hospice providers will be reimbursed at 95% of the SNF’s COVID+ resident base rate for room and board services provided to a COVID+ hospice resident in a SNF COVID-Outbreak or COVID-Response site. 
  • Hospice claims submissions must follow standard billing guidelines to receive 95% of the applicable SNF assigned rate, with one exception: 

Note: Since this rate is applicable only to claims submitted for residents medically confirmed as COVID+, the hospice provider must include the U07.1 COVID-19 diagnosis code on the claim. 

Note: SNF COVID-Outbreak and SNF COVID-Response providers will receive a rate letter confirming their facility-specific temporary COVID-19 increased rates. The increased rates are activated in NCTracks and applied retroactively to claims submitted with dates of service on or after the effective date of the temporary COVID-19 rates. Hospice providers must resubmit claims for COVID+ resident room and board services provided in a SNF COVID-Outbreak or COVID-Response site to receive the targeted increased rates when applicable. 

NC Medicaid will provide updates and additional details regarding the reprocessing of claims meeting the referenced criteria once those details are determined. 

Contact

NC Medicaid Contact Center: 888-245-0179