Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
www.mass.gov/masshealth

MassHealth
Hospice Bulletin 10
August 2013




TO:	Hospice Providers Participating in MassHealth
FROM:	Kristin L. Thorn, Acting Medicaid Director   
RE:	Changes to MassHealth Coverage Types


Background

The Centers for Medicare & Medicaid Services (CMS) recently approved 
an amendment to Massachusetts’s Section 1115 demonstration project, 
entitled “MassHealth” (project number 11-W-00030/1) to include hospice 
services in the MassHealth Basic and MassHealth Essential Programs.
											

Hospice Coverage for members Enrolled in MassHealth Basic and Essential

Members enrolled in MassHealth Basic (see 130 CMR 450.105(B)(1)) and MassHealth Essential (see 130 CMR 450.105(I)(1)) coverage types are eligible to receive hospice services effective July 1, 2013. Specifically, covered services in MassHealth Basic and MassHealth Essential benefit packages include the following hospice services: routine home care; 
continuous home care; inpatient respite care; and general inpatient care 
(described further below). Hospice services are not covered in nursing 
facilities for MassHealth Basic and Essential members.

All other administrative, coverage, and billing requirements of the hospice 
program regulations at 130 CMR 437.00 apply to the provision of hospice 
services to MassHealth Basic and Essential members. 

Payment for Hospice Services for Members Enrolled in MassHealth Basic 
and Essential

Payment for hospice services, as described below, for members enrolled 
in MassHealth Basic and MassHealth Essential coverage types is 
effective July 1, 2013. Rates for hospice services are found at 101 CMR 
343.00. Hospice providers are reminded to check member eligibility in the 
MassHealth Eligibility Verification System (EVS) before submitting 
completed hospice election forms to MassHealth for processing. 
										
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Hospice Coverage for members Enrolled in MassHealth Basic and Essential (cont.)
										

Description of Hospice Services for Members Enrolled in MassHealth
Basic and MassHealth Essential Coverage Types
	
*Routine Home Care: The routine home care rate is paid for each
day the member is at home, under the care of the hospice provider, 
and when the member does not receive continuous home care. The 
rate paid does not depend on the volume or intensity of the routine 
home care provided on any given day. MassHealth pays the hospice 
provider for routine home care only in the community setting, and not 
for services provided in a nursing facility.

*Continuous Home Care: The continuous home care rate is paid when 
a member receives hospice services consisting predominately of 
nursing care on a continuous basis at home. Home health aide or 
homemaker services or both may also be provided on a continuous 
basis. Continuous home care is furnished only during brief periods of 
crisis as described in 42 CFR 418.204(a) and only as necessary to 
maintain the member at home. The hospice provider must give a 
minimum of eight hours of services in a 24-hour period to qualify for 
the continuous home care rate. MassHealth pays the hospice provider 
for continuous home care only in the community setting only, and not 
for services provided in a nursing facility.

*Inpatient Respite Care: The inpatient respite care rate is paid to the 
hospice provider for each day the member is in an approved inpatient 
facility and is receiving respite care from the hospice provider. 
Payment for inpatient respite care will be made for a maximum of five 
consecutive days’ stay in each election period, including the date of 
admission but not counting the date of discharge. Payment for any 
subsequent days will be made at the routine care rate.

*General Inpatient Care: The general inpatient care rate is paid for 
each day the member receives general inpatient care in an inpatient 
facility for pain control or acute or chronic symptom management that 
cannot be managed in other settings. None of the other fixed payment 
rates (room and board, routine home care, continuous home care, or 
inpatient respite care) will apply for a day on which the member 
receives general inpatient care, except for the day of discharge.
											

Questions

If you have any questions about the information in this bulletin, please 
contact MassHealth Customer Service at 1-800-841-2900, e-mail your 
inquiry to providersupport@mahealth.net, or fax your inquiry to 
617-988-8974.
  


			MassHealth
			Hospice Bulletin 10
			August 2013
			Page 2