(Medicare Benefit Policy Manual)

Payment to RNHCIs for these specified DME items will be made based on the DME fee schedule.  Coinsurance applies to these items.  Deductible does not apply to these items.  130.4.2 - Coverage and Payment of Home Visits Under the RNHCI Home Benefit  (Rev. 45, Issued:  02-10-06; Effective:  05-11-06;Implementation:  05-11-06)  Medicare covers intermittent RNHCI nursing visits provided in the home to RNHCI beneficiaries.  The RNHCI nursing personnel may be skilled in ministering to a beneficiarys religious needs (not covered by Medicare), but do not have the training or nursing skill sets required of credentialed/licensed health care professionals (e.g., registered nurse).  While RNHCI nurses may provide tender loving care, they are focused primarily on religious healing and meeting basic beneficiary needs for assistance with activities of daily living (e.g., bathing, toileting, dressing , ambulation), as part of creating a milieu for religious healing.  The care provided by an RNHCI nurse is not at the level of either a registered nurse or a licensed practical nurse.  The physical care provided by an RNHCI nurse is at a level that could b e considered as supportive, but decidedly not skilled as defined by the Medicare program.   For purposes of payment for RNHCI nursing services in the home, the following services are comparable to the services of HHAs that are not RNHCIs (e.g., the RNHCI nurse and the home health aide share the following basic tasks):    Assist with activities of daily living which include: ambulation, bed to chair transfer, and assist with range of motion exercises; bathing, shampoo, nail care and dressing; feeding and nutr ition; and toileting;   Light housekeeping, incident to visit    Documenting visit   By comparison the home health aide will routinely perform additional medically oriented services (e.g., observation and reporting of existing medical conditions, taking and reporting vital signs, and using basic infection control procedures).   Due to the uniqueness of RNHCI nursing in the Medicare program, Medicare pays for RNHCI nursing visits at a percentage of the HHAs low utilization payment adjustment (LUPA) rate for hom e health aides.  Only a visit by an RNHCI nurse to a home will be considered as billable to Medicare.  A visit is defined as an episode in which an RNHCI nurse will render physical care to an RHNCI beneficiary in the home setting.  The visit is a single bi llable unit that is not influenced by the number of involved caregivers or the duration of the episode.  The difference in skill levels and the incorporation of RNHCI religious activity (noncovered by Medicare) into a visit, resulted in a payment rate that  is 80% of the home health aide rate adjusted by metropolitan service area (MSA) wage index rate for the involved RNHCI.   RNHCI nursing visits are paid using the LUPA system even in situations where the involved patient would not be classified as low utili zation.  The HHAs have moved to PPS, which is constructed on the medical model and therefore inappropriate for RNHCI use.  The same labor/non -labor portions applied in the HHA PPS will be used for calculating the RNHCI nursing visit payments.   Example of LUPA Payment:  An RNHCI in Baltimore, MD, provides twelve RNHCI nursing visits over the course of a 30 day period.   1.  Home Health Aide Visit (National standardized rate for 2005)  $44.76  2.  RNHCI Nurse Visit (.80 * $ 44.76)  35.81  3.  Calculate the labor portion of the Standardized       Budget Neutral Per -Visit Payment Amount for       1 RNHCI nurse visit....(.76775 * $.35.81)  27.49  4.  Apply wage index factor for Baltimore, MD..(.9907 * $ 27.49)  27.23  5.  Calculate t he non- labor portion of the      Standardized Budget Neutral Per -Visit Payment      Amount for 1 RNHCI nurse visit.(.23225 * $ 35.81)  8.32  6.  Subtotal Low Utilization Payment Adjustment  (LUPA) wage for 1 RNHCI nurse visit..($ 27.49 + $ 8.32)  $35.55  7.  Total -  Calculate total Low Utilization Payment      Adjustment (LUPA) for 12 RNHCI nurse visits      provided during the 30 -day episode    (12 * $ 35.55)  $426.60  Step 1.  Take the HHA aide visit base rate ($ 44. 76) for the involved year (2005), from the HHA update published annually each November in the Federal Register.  Step 2.  To calculate the RNHCI nurse visit base rate, multiply the HHA base rate ($ 44.76) by the allowed percentage for an RNHCI nurse visit (.80%) to allow for religious activity and reduced physical care skill level = ($ 35.81)   Step 3. To calculate the labor portion of the Standardized Budget Neutral Per -Visit Payment Amount for 1 RNHCI nurse visit, multiply the fixed allowance .76775 by the RNHCI nurse visit r ate ($ 35.81) = ($ 27.49)   Step 4. Apply the wage index for the involved MSA from the HHA update published annually each November in the Federal Register (Baltimore, MD = .9907) multiplied by the labor portion of the RNHCI nurse visit ($ 27.49) = ($27.23).  Step 5. To calculate the non -labor portion of the Standardized Budget Neutral Per -Visit Payment Amount for 1 RNHCI nurse visit, multiply the fixed allowance .23225 by the RNHCI nurse visit rate ($ 35.81) = ($ 8.32)   Step 6. To calculate the LUPA rate for  1 RNHCI nurse visit add the products from Step 4 ($27.49) and Step 5 ($ 8.32) = ($ 35.55)   Step 7. To calculate the LUPA payment for RNHCI nurse visits to one beneficiary in a 30 day period, multiply the product of Step 6 ($ 35.55) by the number of visits  (12) = ($ 426.60)   Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R10892BP  08/06/2021 Internet Only Manual Updates to Publication (Pub.) 100- 02 to Implement Updates to Policy and Correct Errors and Omissions (Inpatient Rehabilitation Facility (IRF)  11/08/2021  12353  R234BP  03/10/2017 Clarification of Admission Order and Medical Review Requirements  06/12/2017  9979 R232BP  12/22/2016 January 2017 Update of the Hospital Outpatient Prospective Payment Sy stem (OPPS)  01/03/2017  9930 R179BP  01/14/2014 Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo vs. Sebelius  01/07/2014  8458 R176BP  12/13/2013 Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo  vs. Sebelius  Rescinded and replaced by Transmittal 179  01/07/2014  8458 R119BP  01/05/2010 Coverage of Inpatient Rehabilitation Services  01/04/2010  6699 R112BP  10/23/2009 Coverage of Inpatient Rehabilitation Services  Rescinded and replaced by Transmittal 119 01/04/2010  6699 R45BP  02/10/2006 Revisions to Instructions for Contractors Other Than the Religious Nonmedical Health Care Institution (RNHCI) Specialty Contractor Regardin g Claims for Beneficiaries with RNHCI Elections  05/11/2006  4218 R25BP  11/05/2004 Implementation of Coverage of Religious Nonmedical Health Care Institution (RNHCI) Items and Services Furnished in the Home, MMA section 706. 04/04/2005  3529 R1BP  10/01/2003 Introduction to the Benefit Policy Manual  N/A N/A Back to top of Chapter