Complete Story
05/22/2019
ODM Clarifies MyCare and Pass-through
As of July 1, 2019, hospices should be billing room and board for all hospice patients residing in nursing facilities, including those individuals who are MyCare Ohio recipients with Molina, Aetna and United Healthcare Plans. Recently, the Managed Care division of ODM shared clarification with all Medicaid managed care plans that stated:
“ODM has reviewed all of the responses submitted by the plans regarding your current policies and practices related to room and board payments to hospice providers for individuals residing in a nursing facility.
Based off the feedback and information we (ODM) received, for hospice services rendered on or after July 1, 2019, the Medicaid Managed Care and MyCare Ohio plans shall pay room and board payments to the hospice provider for individuals residing in a nursing facility in alignment with CMS requirements.”
Therefore, beginning July 1, 2019, hospices should be billing either the Medicaid Managed Care Plan or the Ohio Department of Medicaid (for fee for service Medicaid) for hospice patient room and board services. The nursing facilities should not be billing the Medicaid managed care plans directly for room and board services. This represents a reversal in practice for some plans, while others have already been having hospices bill room and board directly.
Questions regarding billing of room and board services for Medicaid managed care recipients should be directed to Anne Shelley, Director of Regulatory Affairs for Home Health & Hospice at ashelley@leadingageohio.org.