Hospice Coverage for MHS Members
Date: 02/07/19
Managed Health Services (MHS) provides health coverage for members enrolled in Hoosier Healthwise, the Healthy Indiana Plan (HIP) and Hoosier Care Connect. MHS would like to remind providers of the hospice coverage for members in these programs as outlined by the Indiana Health Coverage Program (IHCP) requirements.
- Hoosier Healthwise – MHS is not responsible for covering hospice for Hoosier Healthwise members. MHS members in the Hoosier Healthwise program that are in need of hospice services must be disenrolled from MHS and enrolled in a direct IHCP program such as fee for service.
- Healthy Indiana Plan (HIP) – MHS covers hospice for all HIP members in both institution and home based settings. Room and board are not covered when temporary leave is permitted.
- Hoosier Care Connect – As outlined in IHCP Bulletin BT201809, effective January 1, 2019, MHS covers hospice for Hoosier Care Connect members in both institution and home-based settings.
As a reminder, MHS follows the IHCP policy for inpatient stays as outlined in BT201809.
Also effective Jan 1, 2019, revenue codes 653 and 654, will no longer be reimbursed for any program. The following revenue codes must be billed for all hospice service:
Home Based Settings includes claims billed with a bill type of 81X
- Revenue Code 651 – Routine home care delivered in a private home
- Revenue Code 652 – Continuous home care delivered in a private home
- Revenue Code 657 – Hospice direct care physician service
Institution setting includes claims billed with a bill type of 82X:
- Revenue Code 650- Hospice Service-general
- Revenue Code 655 - Hospice/IP Respite
- Revenue Code 656 - Hospice I/P Non-Respite
- Revenue Code 658- Hospice Service-Room and Board-Nursing Facility
For the most recent changes to hospice billing, please reference the following Bulletins and Banners published by IHCP.
BT201809 – 2019 hospice responsibility for Hoosier Care Connect members
http://provider.indianamedicaid.com/ihcp/Bulletins/BT201809.pdf
BT201852 – New hospice rates for 2019
http://provider.indianamedicaid.com/ihcp/Bulletins/BT201852.pdf
BR201840 – Reminder of face-to-face physician encounter
http://provider.indianamedicaid.com/ihcp/Banners/BR201840.pdf
BR201844 – Revised revenue code billing for hospice services
http://provider.indianamedicaid.com/ihcp/Banners/BR201844.pdf
BR201847 – Clarifies billing for service intensity add-on payments
http://provider.indianamedicaid.com/ihcp/Banners/BR201847.pdf
Authorization Requirement for HIP/Hoosier Care Connect
The provider must submit the IHCP Prior Authorization form, Hospice Election (state form 48737), Hospice Physician Certification (state form 48736) and any pertinent clinical information to the MHS Prior Authorization department via fax at 1-866-912-4245 for processing prior to providing services.
If you call for authorization for hospice care for a member who is not eligible to be covered as outlined above, MHS Medical Management will inform you so you may work with the member to change enrollment from MHS to fee for service Medicaid.
Please contact MHS Provider Services if you have any questions. Thank you for being our partner in care.