Recent Updates and Announcements

< View All Updates And Announcements

New Amendment to Medicaid Contract for Hospice Services
Posted By Admin on July 21, 2017
Text Size

This announcement is pertinent to providers who provide hospice services to Horizon NJ Health members. The New Jersey State Division of Medical Assistance and Health Services (DMAHS) has amended its Medicaid contract with Horizon NJ Health to require the following, to be effective July 1, 2017:

Coordination of and payment for hospice services, including room and board payments to a hospice provider in an nursing facility (NF) setting, must be consistent with federal law.  Federal law requires that in addition to payment for hospice care, “in the case of hospice care which is furnished to an individual who is a resident of a nursing facility or intermediate care facility for …[individuals with intellectual disability], and who would be eligible under the plan for nursing facility services or services in an intermediate care facility for …[individuals with intellectual disability] if he or she had not elected to receive hospice care, there shall be paid an additional amount, to take into account the room and board furnished by the facility, equal to at least 95 percent of the rate that would have been paid by the State under the plan for facility services in that facility for that individual.”   (42 U.S.C. 1396a(a)(13)(B)).  This payment must be made to the hospice provider, not the nursing facility.  (42 U.S.C. 1396d(o)(3)).

Horizon NJ Health is in the process of updating our claims system and fee schedule to make this change effective for services rendered on or after July 1, 2017. We will keep you updated on the progress we are making to implement this change.

Please note that this change does not impact payment for dates of service prior to July 1, 2017. For dates of service prior to July 1, 2017, you will be paid according to the Horizon NJ Health Hospice Provider agreement rate in effect at that time.