Patients electing the Hospice benefit can reside at any location, as long as it is a safe environment for the patient and hospice caregiver and within the hospice agency service coverage area.  If the patient is located in a Long Term Care (LTC) facility, a written agreement is required between the hospice agency and the LTC facility before services are provided.

Required Content in All Contracts with Hospice Agencies

CMS 483.75

• Services the hospice will provide
• Hospice responsibilities for determining the appropriate hospice plan of care
• Services which the LTC facility will continue to provide
• A communication process, including documentation between the facility and the hospice. A provision that the LTC facility immediately notifies hospice about:

• A significant change in status.
• Clinical complications suggesting a need to alter the plan of care.
• A need to transfer the resident for any condition.
• The resident's death.
• The hospice assumes responsibility for determining the appropriate course of hospice care.
• The facility remains responsible for furnishing 24-hr room and board; meets the resident's personal care and nursing needs in coordination with hospice, and ensures care based on resident needs.
• A delineation of hospice responsibilities, including medical direction and management; nursing; counseling (spiritual, dietary, and bereavement); social work; medical supplies, DME, and drugs necessary for palliation of pain /symptoms associated with the terminal illness and related conditions; all other hospice services necessary for care of the resident's terminal illness and related conditions.
• When LTC facility staff are responsible for administration of prescribed therapies, they may administer the therapies where permitted by State law and as specified by the facility.
• The facility must report all alleged mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of property by hospice staff, to the hospice administrator immediately upon becoming aware of the alleged violation.
• A delineation of hospice and facility responsibilities to provide bereavement services to facility staff

Additional Questions

• Type of contract: Single patient agreement or full contract
• Daily reimbursement for services paid to the LTC facility
• General Inpatient (GIP)
• Respite Care
• Medicaid Room & Board
• Reimbursement process
• The monthly billing process for services reimbursable to the LTC facility.  This should include timely filing limits and the handling of payor changes.
• Payment frequency -  Expectation for payment of month services
• Method of reimbursement – Check or EFT

Confirming that all the above information is captured in all of your Hospice contracts will ensure that you are in compliance and have obtained the pertinent information necessary for billing.