23-584m Avoid Claims Delays: SNFs Should Not Bill Room and Board for a Medi-Cal Member on Hospice
Date: 06/29/23
Hospice providers, not SNFs, are to bill for room and board
As a reminder, hospice providers bill for room and board (R&B) charges for a Medi-Cal hospice patient residing in a long-term care (LTC) facility with revenue code 0658. Skilled nursing facilities (SNFs) should not bill for R&B for such members.
Long-term care residents receiving hospice care
Hospice services are covered and not categorized as LTC services regardless of the member's expected or actual length of stay in a nursing facility (NF) while also receiving hospice care. Section 1905(o)(1)(A) of the Social Security Act allows for the provision of hospice care while an individual is a resident of a SNF or intermediate care facility.1
In accordance with the Centers for Medicare and Medicaid Services, the hospice provider reimburses the NF for the room and board at the rate negotiated between the hospice and SNF. Payment for the room and board component must be equal to at least 95 percent of the reimbursement the NF/SNF would have been reimbursed by fee-for-service (FFS) Medi-Cal or California Health & Wellness Plan (CHWP) less the member's share of cost, if applicable. Payments by a hospice provider to a nursing home for room and board are not to exceed what would have been received directly from FFS Medi-Cal or CHWP if the member had not been enrolled in a hospice.1
For more information, refer to the Medi-Cal Provider Manual > Hospice Care Program.
Providers are encouraged to access CHWP’s provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CHWP at 877‑658‑0305.
1 Information taken or derived from Department of Health Care Services All Plan Letter 13-014, Hospice Services and Medi-Cal Managed Care.
This information applies to Ancillary providers.