Utah Admin. Code R414-14A-6 - Reimbursement
(1) Hospice agency and provider reimbursement
for hospice services are made in accordance with the methodologies outlined in
the Utah Medicaid State Plan.
(2)
Reimbursement for services provided during a capped period is limited to the
cap amount and Medicaid does not apply the aggregate caps used by Medicare.
(3) Services provided in a
veteran's administration hospital or military hospital are not
reimbursable.
(4) The hospice
provider may request an exception to the inpatient care reimbursement
limitation if the hospice provider demonstrates the volume of Medicaid
enrollees during the cap period was insufficient to reasonably achieve the
required 20% ratio.
(5) Direct care
provided by a hospice physician, related to the terminal illness or a related
condition, are separately reimbursable.
(6) Service provided by members' attending
physicians are separately reimbursable.
(7) Medicaid reimbursement covers the same
services and amounts covered by the equivalent Medicare reimbursement rate for
comparable service categories.
Notes
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