MedicaidReimbursementHigh impact
Fee-for-service hospice NF rates effective July 1, 2020 – June 30, 2021
Oregon Health Plan·OR · Palliative Care, Geriatrics, Internal Medicine·Provider
Effective date
Jul 1, 2020
We identified it
Aug 19, 2026
Summary
Oregon Health Authority updated fee-for-service hospice per diem rates for nursing facility residents effective July 1, 2020. Revenue codes 658, 191, and 192 (room and board rates) have new rates, and two new codes (190 for NF Bariatric Hospice Services and 194 for NF Vent Hospice Services) were added, each requiring Department of Human Services approval before billing.
Action Required
By July 1, 2020: Billing team must update all hospice billing systems to use new per diem rates for revenue codes 658 (Basic, $334.87), 191 (Complex medical, $468.82), and 192 (Pediatric, $775.87) for nursing facility room and board on RHC and CHC days. For new codes: Before billing revenue code 190 (NF Bariatric Hospice, $619.51) and revenue code 194 (NF Vent Hospice, $786.94), obtain written approval from Department of Human Services AAA/APD office. Update billing rules to correctly differentiate revenue codes 651 (RHC days 1-60) vs. 650 (RHC days 61+) and apply 60-day readmission logic. Ensure nursing staff document services meeting Service-Intensity Add-on (SIA) payment criteria for RN/social worker services in last 7 days of life. Update billing software to bill at the correct CBSA rate table based on geographic service area. Failure to obtain DHS approval for codes 190 and 194 will result in claim denials.