Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-51 - HOSPICE CARE › Section 560-X-51-.10 - Reimbursement For Levels Of Care

Current through Register Vol. 42, No. 9, June 28, 2024
(1) With the exception of payment for direct
			 patient care services by physicians, payment is made to the hospice for all
			 covered services related to the treatment of the recipient's terminal illness
			 for each day during which the recipient is Medicaid eligible and under the care
			 of the hospice regardless of the amount of services furnished on any given
			 day.
(2) Payment for hospice care
			 must conform to the methodology and amounts calculated by the Centers for
			 Medicare and Medicaid Services (CMS). Medicaid hospice payment rates are based
			 on the same methodology used in setting Medicare rates and adjusted to
			 disregard offsets attributable to Medicare coinsurance amounts. Each rate is a
			 prospectively determined amount which CMS estimates generally equals the costs
			 incurred by a hospice in efficiently providing hospice care services to
			 Medicaid beneficiaries. The rates will be adjusted by Medicaid to reflect local
			 differences in wages.
(3) With the
			 exception of payment for physician services as outlined in Rule
			 560-X-51-.11, Medicaid
			 reimbursement for hospice care will be made at one of four rates for each day
			 in which a Medicaid recipient is under the care of hospice. The payment amounts
			 are determined within each of the following categories:
(a) Routine home care. The hospice shall
			 receive reimbursement for routine home care for each day the recipient is at
			 home, under the care of the hospice, and not receiving continuous home care.
			 This rate is paid without regard to the volume or intensity of routine home
			 care services provided on any given day.
(b) Continuous home care. The hospice shall
			 receive reimbursement for continuous home care when, in order to maintain the
			 terminally ill recipient at home, nursing care is necessary on a continuous
			 basis during periods of crises. Continuous home care is intended only for
			 periods of crises where predominantly skilled nursing care is needed on a
			 continuous basis to achieve palliation or management of the recipient's acute
			 medical symptoms; and only as necessary to maintain the recipient at home. A
			 minimum of eight (8) hours per day must be provided. For every hour or part of
			 an hour of continuous care furnished, the hourly rate will be reimbursed to the
			 hospice up to 24 hours a day.
(c)
			 Inpatient respite care. The hospice shall receive reimbursement for inpatient
			 respite care for each day that the recipient is receiving respite care.
			 Patients admitted for this type of care are not in need of general inpatient
			 care. Inpatient respite care may be provided only on an intermittent,
			 non-routine, and occasional basis and may not be reimbursed for more than five
			 consecutive days, including date of admission, but not date of
			 discharge.
(d) General inpatient
			 care. The hospice shall be reimbursed for general inpatient care for each day
			 that the recipient is in an approved inpatient facility for pain control or
			 acute or chronic symptom management. Payment for total inpatient care days
			 (general or respite) for Medicaid patients cannot exceed twenty percent of the
			 aggregate total number of days of hospice care provided to all Medicaid
			 recipients during each 12-month period of November 1 through October
			 31.