MedicaidReimbursementMedium impact
PT 25-26: Clarification of HealthChoice Reimbursement and Payment Responsibility for the Hospice Room and Board Pass-Through Process
Maryland Medicaid·MD · Palliative Care·Claims & Billing
Effective date
Sep 30, 2025
We identified it
Jun 18, 2026
Summary
This policy clarifies that HealthChoice Medicaid MCOs must pay hospice providers an additional per diem amount for room and board when participants reside in nursing facilities. The hospice provider must then pass this payment through to the nursing facility, and a written agreement between hospice and nursing facility is required.
Action Required
Immediately: Billing teams at hospice providers must verify written agreements exist with all nursing facilities before billing HealthChoice MCOs for room and board pass-through payments. Update billing workflows to ensure room and board charges are only billed on days when routine or continuous home care hospice services are provided. Nursing facility billing teams must coordinate with hospice providers to cease billing MCOs for participants receiving hospice care.