Medicaid Managed Care and Hospice

Advanced Illness Care for Your Medicaid and Dual-Eligible Residents

Many states contract with managed care organizations to deliver Medicaid services to beneficiaries. As your preferred partner, VITAS Healthcare and its specialists can provide you with a better understanding of the hospice benefit and end-of-life care. You can be confident that your residents with advanced illness are receiving appropriate care, and that claims administration is accurate and efficient.

VITAS has the expertise, experience and infrastructure to care for your residents. An interdisciplinary team addresses the physical, emotional and spiritual needs of patients and their families. A physician, nurse, hospice aide, chaplain, social worker and volunteers care for patients wherever they call home.

Facts About Hospice and Medicaid

  • Your state Medicaid agency publishes reimbursement rates for core hospice services and nursing facility daily room and board. Check regularly for updates, as many times these are revised annually—sometimes even more frequently.
  • Hospice coordinates members’ care to prevent duplication of services, as mandated by the Centers for Medicare and Medicaid Services (CMS)
  • Typically when a patient elects hospice, the nursing facility room and board is paid by the Medicaid Managed Care entity directly to the hospice. The hospice organization then “passes” the payment to the nursing facility. Typically, only 95 percent of the nursing facility room and board charge should be paid by the Managed Care Organization when the member is a hospice patient in a nursing facility. This payment model and pass-through system may vary based on individual state Medicaid Agencies.

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