(1) Medicaid payment for covered hospice care will be made in accordance with the specific categories of covered hospice care (routine home care day, continuous home care day, inpatient respite care day, and general inpatient care day) and the payment amounts and procedures established by Medicare.

(2) The department adopts and incorporates by reference 42 CFR 418.302, effective August 6, 2015, and 42 CFR 418.306, effective August 6, 2015, which sets forth the Medicare payment procedures. Copies of 42 CFR 418.302 and 42 CFR 418.306 are available at the federal web site: http://cms.hhs.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/index.html.

(3) The board and room rate to be paid a hospice for a Medicaid recipient who resides in a nursing facility will be the Medicaid rate established by the department in ARM 37.40.307 for the individual facility minus the amount the recipient pays toward his own cost of care. Payment for board and room will be made to the hospice and, in turn, the hospice will reimburse the nursing facility. General inpatient care or hospice respite care in a nursing facility will not be reimbursed directly by the Medicaid program when a Medicaid recipient elects the hospice benefit payment. Under such circumstances payment will be made to the hospice in accordance with this rule.

(a) In this context, the term "room and board" includes performance of personal care services, including assistance in the activities of daily living, socializing activities, administration of medication, maintaining the cleanliness of a resident's room, and supervision and assisting in the use of durable medical equipment and prescribed therapies.

(4) The following services performed by hospice physicians are included in the rates described in (1) and (2) of this rule:

(a) general supervisory services of the medical director; and

(b) participation in the establishment of plans of care, supervision of care and services, periodic review and updating of plans of care, and establishment of governing policies by the physician member of the interdisciplinary group.

(5) For services not described in (4), Medicaid will pay the hospice for those physician services furnished by hospice employees or under arrangements with the hospice in accordance with ARM 37.86.101, 37.86.104 and 37.86.105. Reimbursement for these physician services is included in the amount subject to the hospice limit described below. Services furnished voluntarily by physicians are not reimbursable.

(6) Services of the patient's attending physician, if he or she is not an employee of the hospice or providing services under arrangements with the hospice, are not considered hospice services and are not included in the amount subject to the hospice payment limit.

(7) Medicaid reimbursement to a hospice in a cap period is limited to a cap amount established using Medicare principles.

(8) The department adopts and incorporates by reference 42 CFR 418.309, effective August 6, 2015, which sets forth Medicare's methodology for calculating the hospice cap amount. Copies of 42 CFR 418.309 are available at the federal web site: http://cms.hhs.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/index.html.

(9) The department will notify the hospice of the determination of program reimbursement at the end of the cap year.

(10) Payments made to a hospice during a cap period that exceed the cap amount are overpayments and must be refunded.

(11) The hospice fee schedules are effective October 1, 2015. Copies of the department's current fee schedules are posted at http://medicaidprovider.mt.gov and may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1401 East Lockey, P.O. Box 202951, Helena, MT 59602-2951.