Rhode Island Hospice General Inpatient Claims and Payments Did Not Always Meet Federal and State Requirements.

摘要

The Rhode Island Executive Office of Health and Human Services, Office of Medicaid (State agency), is responsible for administering the Rhode Island Medicaid program, in compliance with Federal and State statutes and administrative policies. State agencies have the option of offering hospice care as a benefit to eligible Medicaid members. A hospice is a public agency, private organization, or a subdivision of either that is primarily engaged in providing care to terminally ill individuals. The hospice must provide services for the palliation and management of the terminal illness and related conditions. Each day of hospice care is classified under four levels of care: (1) routine home care, (2) continuous home care, (3) inpatient respite care, and (4) general inpatient care. In order to qualify for reimbursement at the general inpatient care level, the hospice must document that a beneficiary's need for pain control or chronic symptom management is beyond the routine home care level of care. Federal regulations require the State agency to use certain additional beneficiary financial contributions to reduce Medicaid payments.