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DEPARTMENT OF SOCIAL AND HEALTH SERVICES MEDICAL ASSISTANCE ADMINISTRATION Olympia, Washington To: Hospice Agencies Managed Care Plans CSO Administrators Regional Administrators Douglas Porter, Assistant Secretary Medical Assistance Administration Memorandum No: 02-85 MAA Issued: December 1, 2002 For More Information, call: Toll Free: 1-800-562-6188 Supersedes: 01-67 MAA

From:

Subject: New Rates for Hospice Services Retroactive to dates of service on and after October 1, 2002, the Medical Assistance Administration (MAA) implemented and began using the attached Hospice Fee Schedule. Attached are replacement pages 25-28 for MAA's Hospice Billing Instructions, dated May 1999. To obtain this memorandum electronically, go to MAA's website at http://maa.dshs.wa.gov (click on the Provider Publications/Fee Schedules link). Address all reimbursement questions or comments in writing to: Professional Reimbursement Section Division of Budget and Finance Medical Assistance Administration Department of Social and Health Services PO Box 45510 Olympia, WA 98504-5510

Attachment

Hospice

Hospice Revenue Codes

Enter the following revenue codes and service descriptions in the appropriate form locators.

Code #

651 652

Description of Code

Routine Home Care - The established rate is a capitated rate regardless of the volume or intensity of routine home care services provided on any given day. Continuous Home Care - For every hour or part of an hour of continuous care, the hourly rate is reimbursed to the hospice up to 24 hours a day. Bill continuous care as a separate line entry on the UB-92 claim form for each day this level of care is provided. Nursing Facility Room and Board - Enter the words "Room and Board" in form locator 43. Enter the nursing facility's name or provider number in form locator 83 or in the Remarks form locator. Inpatient Respite Care 1) MAA will pay for respite care for a maximum of five (5) consecutive days. 2) MAA will deny the entire claim if the hospice agency bills for more than five (5) consecutive days of respite care. 3) Bill MAA for the sixth and subsequent days at the routine home care rate. 4) Itemize the individual days of inpatient respite care services on the UB-92 claim form. 5) If the client dies during the five-day respite period, bill MAA the respite rate for the ending date of service.

653

655

656

General Inpatient Care - Bill the day of discharge from the hospital at the routine home care rate. If the client dies in the hospital, bill MAA the general inpatient rate for the ending date of service.

May 1999

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Hospice Revenue Codes

Hospice

Fee Schedule

Hospice Services Provided Inside Client's Home

Counties (Non-MSA & MSA Areas) Routine Continuous County Home Care Home Care Hourly Code (651) (652)

WASHINGTON

Non-MSA Areas Adams, Asotin, Chelan, Clallam, Columbia, Cowlitz, Douglas, Ferry, Garfield, Grant, Grays Harbor, Jefferson, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, San Juan, Skagit, Skamania, Stevens, Wahkiakum, Walla Walla, Whitman MSA Areas Benton (Kennewick-Richland) Clark (Vancouver) Franklin (Pasco) Island King, Snohomish (Seattle-Everett) Kitsap (Bremerton) Pierce (Tacoma) Spokane (Spokane) Thurston (Olympia) Whatcom (Bellingham) Yakima (Yakima) 6740 6440 6740 7600 7600 1150 8200 7840 5910 0806 9260 $127.19 $128.45 $127.19 $130.54 $130.54 $125.50 $132.66 $124.75 $130.44 $134.41 $123.91 $30.93 $31.23 $30.93 $31.74 $31.74 $30.52 $32.26 $30.34 $31.72 $32.69 $30.13

9950

$120.92

$29.40

* MSA = Metropolitan Statistical Area

(Revised October 2002) # Memo 02-85 MAA

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Fee Schedule

Hospice

Hospice Services Provided Outside Client's Home

Non-MSA Areas & MSA Areas Inpatient Respite (655) General Inpatient Care (656)

Provider Name WASHINGTON

Assured Home Health & Hospice Central Basin Home Health & Hospice Central Washington Hospital Hospice Community Home Health & Hospice Harbors Home Health Services Home Care of Kittitas Valley Hospice of the Gorge Okanogan Regional Hospice Tri-State Hospital Hospice Walla Walla Community Hospice Whitman Home Health & Hospice Tri-Cities Chaplaincy Hospice Southwest Community Health Service Evergreen Hospice & Home Health Highline Home Health & Hospice Hospice of Seattle Hospice of Snohomish County Swedish Home Health & Hospice Visiting Nurse Services of the NW

Non-MSA Areas

$123.60 $123.60 $123.60 $123.60 $123.60 $123.60 $123.60 $123.60 $123.60 $123.60 $123.60 $128.71 $129.74 $131.44 $131.44 $131.44 $131.44 $131.44 $131.44 $131.44

$535.85 $535.85 $535.85 $535.85 $535.85 $535.85 $535.85 $535.85 $535.85 $535.85 $535.85 $561.83 $567.06 $575.71 $575.71 $575.71 $575.71 $575.71 $575.71 $575.71

MSA Areas (Counties) Benton (KennewickRichland) Clark (Vancouver)

King, Snohomish (Seattle-Everett)

* MSA = Metropolitan Statistical Area

(Revised October 2002) # Memo 02-85 MAA

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Fee Schedule

Hospice

Hospice Services Provided Outside Client's Home (cont.)

Non-MSA Areas & MSA Areas Inpatient Respite (655) General Inpatient Care (656)

Provider Name WASHINGTON

Kitsap (Bremerton) Pierce (Tacoma)

Hospice of Kitsap County Good Samaritan Hospice Multicare Hospice of Tacoma St. Joseph Hospital Hospice Spokane (Spokane) Hospice of Spokane Horizon Hospice Thurston (Olympia) Providence Sound Home Care Whatcom Skagit Hospice (Bellingham) Whatcom Hospice Hospice of Yakima Yakima (Yakima) Lower Valley Hospice Memorial Home Care Services

$127.34 $133.18 $133.18 $133.18 $126.73 $126.73 $131.37 $134.60 $134.60 $126.04 $126.04 $126.04

$554.84 $584.52 $584.52 $584.52 $551.75 $551.75 $575.32 $591.78 $591.78 $548.23 $548.23 $548.23

BORDER AREAS

Multnomah (OR) Kaiser Permanente Hospice $129.74 $567.06

* MSA = Metropolitan Statistical Area

(Revised October 2002) # Memo 02-85 MAA

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Fee Schedule

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