23-583m 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 the Plan 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 the Plan if the member had not been enrolled in a hospice.1
Resources
For more information, refer to the following resources.
- Medi-Cal Provider Manual: View the Medi-Cal Provider Manual > Hospice Care Program.
- The provider operations manual in the Provider Library:
Use one of the two following options to access the Provider Library.
Option 1 – Log in on the Provider Portal
Log in at provider portal.
Select Provider Library under Quick Links.
Option 2 – Go directly to the Provider Library
Go to provider library > Hospice.
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.
1Information 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.
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.