MedicaidReimbursementHigh impact
Fee-for-service hospice rates effective April 1, 2020 through June 30, 2020
Oregon Health Plan·OR · Palliative Care·Provider
Effective date
Apr 1, 2020
We identified it
Aug 19, 2026
Summary
Oregon Medicaid has temporarily increased fee-for-service hospice rates for nursing facility room and board (revenue codes 658, 191, and 192) effective April 1 through June 30, 2020 as part of COVID-19 response. Hospice providers must bill these updated per diem rates and track service-intensity add-on (SIA) payments for RN/social worker services in the final seven days of patient life for future claims submission.
Action Required
By April 1, 2020: (1) Billing team must update billing system with new per diem rates for revenue codes 658 (Basic: $359.15), 191 (Complex Medical: $502.81), and 192 (Pediatric: $805.65) for nursing facility room and board charges. (2) Update billing rules to apply correct CBSA-based rates for Routine Home Care days 1-60 (code 651), days 61+ (code 650), and Continuous Home Care (code 652) based on service location. (3) Providers must document and track services provided by RN or social worker in the last seven days of hospice patient life that meet SIA payment criteria per MLN Matters MM9201. (4) For patient readmissions within 60 days: ensure prior hospice days are counted when determining billing rate; for readmissions over 60 days: reset to day 1 rates unless patient switches hospice providers with less than 60-day break. (5) Ensure Value Code 61 is entered on institutional claims with CBSA code as dollar amount (e.g., 13460.00). Note: This rate increase expires June 30, 2020. Failure to apply correct rates will result in underpayment or claim denials.