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Special Report: Part III

Part 3 of 6 in a Special Report on Concurrent Care

Guidelines for the payment of concurrent care vary widely in that some states make no mention of concurrent care; some states simply express that providers of curative services will be reimbursed for those services and some states clearly designate which providers should file specifically mentioned forms and claims. Those states which make no mention of concurrent care most often follow the guidelines of reimbursement for adult clients over age twenty-one and detail that reimbursement would be based on one of four predetermined rates: routine home care, continuous home care, inpatient respite care, and general inpatient care. A brief description of each of these four levels often follows. South Carolina, Iowa and New York ascertain that concurrent care will be reimbursed, but do not denote specific forms providers should utilize. Specifically, South Carolina points out the South Carolina Department of Health and Human Services (SCDHHS) will provide reimbursement for hospice services for minors under age twenty-one in conjunction with the curative treatment of the child’s terminal illness. In Iowa, state Medicaid pays for curative treatment and hospice care separately after private insurance does its part. Members under the age of twenty-one residing in New York enrolled in Medicaid, Medicaid managed care, FHPlus or CHPlus may receive payment for concurrent care. Some states have laid out more specific guidelines providers, which will be covered thereafter. For Indiana Health Coverage Program (ICHP) members, palliation and management of the terminal condition fall under the supervision of the IHCP hospice provider, whereas curative services are covered separately from hospice services. Concurrent curative services shall be billed separately by those providing the curative services under the appropriate diagnosis codes, procedure codes, and claim type. Conversely, non-hospice providers in Kansas must first bill hospice to receive a payment or denial for the service provided. If the payment is denied by hospice, the non-hospice provider must then submit a paper claim containing documentation of medical necessity and a hospice denial form for review. Throughout Michigan, hospice services and curative treatment are billed and reimbursed separately. Prior to filing for reimbursement, the provider must clearly differentiate which services are palliative and are included in hospice reimbursement and which are curative and separately reimbursable under Medicaid.