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Hospice providers ask senators to fix room‑and‑board pass‑through reimbursement for nursing‑home residents
Summary
Hospice representatives said Ohio's rule requiring hospices to pass through a percentage of nursing‑home room and board to operators leaves hospices under‑reimbursed, diverts resources from patient care and risks market distortion.
Mark Knepper, general manager for VITAS Healthcare in Ohio, told the Senate Medicaid subcommittee that the current room‑and‑board pass‑through process for hospice patients in nursing homes and intermediate care facilities creates operational and financial burdens.
Knepper said hospices bill Medicaid for room and board and remit a pass‑through payment to the nursing home, but the hospice is reimbursed for only 95 percent of the total rate. He described wide variation in facility rates — from standard nursing‑home rates up to higher ventilator rates that he said can reach $1,400 per day — and said the 95 percent pass‑through obligation can create losses, administrative burden and cash‑flow delays for hospices.
Knepper asked legislators to consider amending the pass‑through percentage upward or otherwise adjusting the payment structure to avoid diverting hospice resources from patient care and to mitigate the competitive disadvantage that can arise if some providers pass through 100 percent while others cannot afford to do so. No formal action was taken during the hearing.
