Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: HOSPICE › Section 16.03.10.458 - HOSPICE: PAYMENT FOR PHYSICIAN SERVICES

Current through August 31, 2023
The basic rates for hospice care represent full reimbursement
				  to the hospice for the costs of all covered services related to the treatment
				  of the participant's terminal illness, including the administrative and general
				  activities performed by physicians who are employees of or working under
				  arrangements made with the hospice. These activities would generally be
				  performed by the physician serving as the medical director and the physician
				  member of the hospice interdisciplinary group. Group activities include
				  participation in the establishment of plans of care, supervision of care and
				  services, periodic review and updating of plans of care, and establishment of
				  governing policies. The costs for these services are included in the
				  reimbursement rates for routine home care, continuous home care, and inpatient
				  respite care. (3-17-22)
01.
Hospice Employed Physician Direct Patient Service
. Reimbursement for a
				hospice employed physician's direct patient services that are not rendered by a
				hospice volunteer is made in accordance with the usual Idaho Medicaid
				reimbursement methodology for physician services. These services will be billed
				by the hospice under the hospice provider number and, the related payments will
				be counted in determining whether the overall hospice cap amount per Section
				459 of these rules has been
				exceeded. The only physician services to be billed by a hospice for such
				services are direct patient care services. Laboratory and X-ray services are
				included in the hospice daily rate. (3-17-22)
02.
Volunteer Physician
				Services
. Volunteer physician services are excluded from Medicaid
				reimbursement with the following exceptions: (3-17-22)
a. A hospice may be reimbursed on behalf of a
				volunteer physician for specific direct patient care services that are not
				rendered on a volunteer basis. The hospice must have a liability to reimburse
				the physician for those services rendered. In determining whether a service is
				provided on a volunteer basis, a physician must not distinguish which services
				are provided voluntarily on the basis of the patient's ability to pay.
				(3-17-22)
b. Reimbursement for an
				independent physician's direct patient services that are not rendered by a
				hospice volunteer is made in accordance with the usual Idaho Medicaid
				reimbursement methodology for physician services. These services will not be
				billed by the hospice under the hospice provider number and they will not be
				counted in determining whether the overall hospice cap amount per Section
				459 of these rules has been
				exceeded. The only services to be billed by an attending physician are the
				physician's personal professional services. Costs for services such as
				laboratory or X-rays are not to be included on the attending physician's billed
				charges to the Medicaid program. The aforementioned charges are included in the
				daily rates paid and are expressly the responsibility of the hospice.
				(3-17-22)