Myers and Stauffer LC is the long-term care rate-setting
contractor that sets the Indiana Health Coverage Programs (IHCP)
rates for nursing facilities, hospices, home health agencies, and
group homes. Hospice providers can obtain current rate information
for a particular nursing facility by accessing the Myers and Stauffer
long-term care website and following these steps:
- Click Long Term Care located on the left.
- Click Nursing Facility.
- Click the Other Reports folder for a list of
- From the list of reports, click Cumulative Rate
- You will be presented with a report listing Medicaid rates for
all Medicaid-certified nursing facilities. Medicaid rates are
updated within 24 hours of finalization.
Reimbursement for IHCP hospice benefits is based on the
methodology established by the Centers for Medicare & Medicaid
Services (CMS) for the administration of the federal Medicare
program adjusted to disregard offsets attributable to Medicare
coinsurance amounts. Additionally, IHCP rates are further adjusted
for regional wage differences.
The annual hospice rates are effective October 1 of each year
through September 30 of the following year, and are announced via
IHCP Bulletins. Providers
can search for the most recent announcement at the Bulletins page
(search for "hospice rates").
The IHCP reimburses hospice providers for hospice services in a
hospice facility, in a nursing facility, and in a private home.
Enrollment statistics historically reflect that the majority of
individuals enrolled through the IHCP hospice benefit reside in
nursing facilities. Hospice services provided in a nursing facility
are reimbursed at 95% of the nursing facility case-mix rate on file
when billing the IHCP for room and board under the hospice benefit
using hospice revenue codes 653, 654, and 659. The IHCP pays the
hospice provider 95% of the lowest nursing facility rate, so the
hospice provider may reimburse the nursing facility according to
The CMS rule 1629-F revised reimbursement for routine home care
hospice services, applying a higher per diem rate to
routine home care services rendered during the first 60 days of
hospice care and a reduced per diem rate to routine home
care services rendered on days thereafter. These differing rates
serve to capture the varying levels of resource intensity necessary
during the course of providing routine home care hospice services.
The rule also established a service intensity add-on (SIA) payment
for face-to-face services provided by a registered nurse (RN) or
social worker during the last seven days of a member's life.
For more information about IHCP hospice services, including
billing guidance, see published IHCP bulletins, the
Medical Policy Manual, and the Hospice
Services provider reference module - all on this site.