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Reimbursements for Hospice Room and Board Services in ICF/DD Facilities

November 28, 2018

State Plan Amendment (SPA) 18-0029 authorizes a time-limited supplemental payment to Intermediate Care Facilities for the Developmentally Disabled (ICF/DD), including ICF/DD-Habilitative (ICF/DD-H) and ICF/DD-Nursing (ICF/DD-N). Currently, when a patient resides in an ICF/DD and elects to receive hospice care, the hospice room and board services are reimbursed at 95 percent of the facility’s per diem rate, not including the supplemental payment. Effective for dates of service on or after August 1, 2018, the Department of Healthcare Services (DHCS) will reimburse hospice providers for room and board services at 95 percent of the total per diem reimbursement, which will include the 2018 – 2019 facility per diem rate plus the supplemental payment per diem amount authorized by SPA 18-0029 for patients residing in an ICF/DD facility.

The additional reimbursement will be paid on a quarterly basis, beginning on or about December 2018, for hospice room and board service bed days rendered in the immediately preceding quarter, beginning with the quarter spanning August 1, 2018, through October 31, 2018. The additional quarterly reimbursements will be paid through warrants issued by the State Controller’s Office and will be paid separately and in addition to the usual hospice room and board reimbursements paid through the California Medicaid Management Information System (CA-MMIS) Fiscal Intermediary. DHCS may contact affected providers for additional information if needed to process reimbursements. This additional reimbursement is subject to the availability of funds.

Claims submitted with revenue code 0658 for room and board services will receive the additional reimbursement. Hospice providers should continue to bill as usual. No additional action is required of providers.

For further information related to ICF/DD, ICF/DD-H and ICF/DD-N rates and supplemental payments, providers should email LTCReimbursement@dhcs.ca.gov.