The Ohio Department of Medicaid (ODM) now requires managed care plans in that state to make room and board payments directly to hospice providers whose patients reside at skilled nursing facilities (SNF). The rule became effective July 1.
ODM now requires the hospice to bill for room and board services provided at SNFs. The Buckeye Health Plan, United Healthcare Community Plan, Aetna Better Health and Molina health plans have indicated that they will only accept billing for such services from the hospice provider.
The change occured to make ODM policies consistent with U.S. Centers for Medicare & Medicaid (CMS) regulations, which require payments to go to the hospice provider, which the agency considers to be the provider of record. The payments cannot be reassigned.
“SNFs should review their contracts with hospice providers regarding the assignment of payment to make sure they are compliant with regulations,” ODM indicated. “We recommend hospice providers perform a Medicaid eligibility check on all inpatient residents to ensure all patients with room and board components are identified and authorizations, if required, can be requested without penalty or delay.”
Prior to this policy change, SNFs would bill the state Medicaid program for nursing home care, including room and board. The Medicaid agency would make the payment to the hospice, which would then reimburse the SNF.
Some health plans in Ohio have released guidelines for room and board billing processes for hospices and SNFs. United Healthcare issued a billing guide to help hospices and SNFs work through the changes. Aetna sent similar information to providers in its plan.
“Agencies should run a Medicaid eligibility on all nursing facility residents on July 1 to determine if you need to set up room and board for billing purposes and revenue recognition,” United Healthcare said in a statement. “This will be especially important for residents who utilize UnitedHealthcare Community Plan for the managed Medicaid, as they will need a single case agreement and authorization for all out of network hospice providers.”