SPECIAL BULLETIN COVID-19 #114: Hospice Room and Board Reimbursement Rate Increase and Clarification of COVID-19 Rate Billing Guidelines for Skilled Nursing Facilities and Hospice Providers

Monday, July 20, 2020

This NC Medicaid Bulletin describes:

  1. Overview of COVID-19 rate increases applicable to SNFs and Hospice providers
  2. Hospice provider rate increase from 95% to 100% of Skilled Nursing Facility (SNF) reimbursement rates for room and board services provided in a SNF
  3. Billing guidelines for Hospice services provided in a SNF designated as a “COVID-19 Outbreak” or “COVID-19 Response” site

Overview of COVID-19 SNF and Hospice Rate Increases

SNF

  • 5% increase effective March 1, 2020 (all SNFs)
  • 10% increase effective April 1, 2020 (all SNFs)
  • $86.64 add-on for non-COVID-19+ residents in a SNF COVID-19 Outbreak or Response site effective as early as April 1, 2020, but dependent on the month of the Outbreak designation
  • $86.64 + $561 add-on for COVID-19+ residents in a SNF COVID-19 Outbreak or Response site effective as early as April 1, 2020, but dependent on the month of the Outbreak designation date and the date the resident was determined to be COVID-19+.

Hospice

  • 5% increase effective March 10, 2020 through Sept. 30, 2020 (excluded room and board)
  • Hospice room and board reimbursement rate increase from 95% to 100% of the applicable SNF rate. Retroactive to April 1, 2020, for SNFs that are not designated as a COVID-19 Outbreak or Response site.
  • 100% of the COVID-19 add-on rates retroactive to the following dates: 
    • First day of the month in which the SNF is designated as a COVID-19 Outbreak or Response site. 
    • Dependent on the date the resident was determined to be COVID-19+ within the SNF designated as a COVID-19 Outbreak or Response site. 

Hospice Rate Increase

Retroactive to April 1, 2020, all Hospice providers will be reimbursed at 100% of the applicable SNF rate for room and board services rendered within a SNF. This rate increase applies to all SNF facility rates regardless of the SNF’s status during the COVID-19 pandemic. Implementation of this change is currently in progress and will be activated in NCTracks by July 20, 2020.

NC Medicaid will systematically reprocess all Hospice claims submitted for room and board services within a SNF with date of service from April 1, 2020 through the implementation date of the revised reimbursement percentage. All Hospice claims eligible for the COVID-19+ rate submitted prior to the implementation date of this increase will require resubmission by the provider and the COVID-19+ diagnosis code U07.1 must be present on the resubmitted claim.

Rate Eligibility and Billing Guidelines

Hospice Services in a SNF Not Designated as a COVID-19 Outbreak or Response Site 

Hospice providers in this category may bill only at the SNF base rates indicated on the SNF’s Medicaid rate letters for the applicable dates of service. SNF fee schedule rates are also posted on the NC Medicaid website. Rates for SNFs that are not designated as COVID-19 Outbreak or Response sites do not include any COVID-19 add-on amounts. 

All SNFs received a 5% rate increase effective March 1, 2020, and a 10% rate increase effective April 1, 2020. These percentage increases were applied to the SNF base rate that was active on the effective dates of the increases.

Retroactive to April 1, 2020, Hospice providers will be reimbursed at 100% of the applicable SNF base rate for room and board services provided for a Hospice resident within the SNF.

Hospice Services in a SNF Designated as a COVID-19 Outbreak or Response Site

Hospice reimbursement is based on one of two COVID-19 base rates established for SNFs when they meet the criteria for designation as either COVID-19 Outbreak or Response sites.

  1. COVID-19+ Outbreak Site Rate = facility base rate prior to the COVID-19 Outbreak designation plus $86.64
  2. COVID-19+ Resident Rate = the facility base rate prior to the COVID Outbreak designation plus $86.64 in addition to $561.00
  • COVID-19+ Outbreak Site Rate
    • The COVID-19+ Outbreak Site Rate is retroactive to the first day of the month that the facility is designated as a COVID-19+ Outbreak or Response site.
    • The Outbreak Site Rate can be billed only for residents who are not COVID-19+ but are receiving care during the period the SNF is designated as a COVID-19+ Outbreak or Response site. 
    • Hospice providers will be reimbursed at 100% of the SNF’s COVID-19+ Outbreak Site Rate for room and board services provided to a Hospice resident who is not COVID-19+. 

          Hospice claims submissions should follow standard billing guidelines to receive 100% of the applicable SNF assigned rate.

  • COVID-19+ Resident Rate
    • SNFs may bill at the COVID-19+ Resident Rate only for each COVID-19+ resident from the date each individual resident is medically determined to be COVID-19+. The Resident Rate is applicable only during the period the SNF is designated as a COVID-19+ Outbreak or Response site. 
    • Hospice providers will be reimbursed at 100% of the SNF’s COVID+ Resident Rate for room and board services provided to a COVID-19+ Hospice resident. 
    • Hospice claims submissions should follow standard billing guidelines with one exception. Since the COVID-19+ Resident Rate is applicable only to claims submitted for residents medically confirmed as COVID-19+, the U07.1 COVID-19 diagnosis code must be present on the Hospice claim. 

Note: SNF COVID-19+ Outbreak and Response site providers receive a rate letter confirming the effective date of their facility-specific temporary COVID-19 rates. The COVID-19 rates are activated in NCTracks and applied retroactively to claims submitted with dates of service on or after the effective date of the rates. Both SNF and Hospice providers must resubmit claims for COVID-19+ residents previously submitted without the U07.1 COVID-19 diagnosis code present on their claims to receive the targeted COVID-19+ Resident Rates when applicable.