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Implementation of Hospice Payment Reforms

The Centers for Medicare and Medicaid Services (CMS) have issued Medlearn Matters article # MM9201, entitled: Implementation of the Hospice Payment Reforms.  The article provides details on the following:

-          A service intensity add-on (SIA) payment for social worker and nursing visits provided during the last 7 days of life; and

-          Two routine home care (RHC) rates, paying a higher rate in the first 60 days and a lower rate for days 61+.

In addition to the article, CMS has updated chapter 11, sections 20.1.2, 30.1, 30.2, and 30.2.2 of the Medicare Claims Processing Manual to reflect these changes.

CMS considers a hospice “episode” of care to be a hospice election period or series of election periods. Under the new rules effective Jan. 1, 2016, days 1 through 60 will be paid at the RHC ‘High’ Rate while days 61+ will be paid at the RHC ‘Low’ Rate.   With these differing rates CMS hopes to reflect their analysis that indicates varying levels of resource intensity during the course of hospice care, as the beginning portion of the stay is generally more costly than the later segment.

Also effective Jan. 1, 2016, CMS will be implementing an end of life SIA for claims that meet the following criteria:

-           The day is an RHC level of care day;

-           The day occurs during the last seven days of life;

-          Service is provided by a Registered Nurse or social worker that day for at least 15 minutes and up to 4 hours total; and

-          The service is not provided by a social worker via telephone.

For more details, including a discussion of how to handle patients with more than one admission, please refer to the article linked above.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827