Annual Update to Medicaid Hospice Payments
The Centers for Medicare and Medicaid Services (CMS) have issued Memo to CMS Regional Offices: Annual Change in Medicaid Hospice Rates for 2016 effective with the federal fiscal year (FY) 2016, which starts Oct. 1, 2015. The guidance includes information on higher base payment for the first 60 days of hospice care and a service intensity add-on (SIA) payment. Implementation of both of these provisions is delayed until Jan. 1, 2016. The changes for FY 2016 do not include an increase in rates for hospice physician services.
The Medicaid hospice payment rates are calculated based on the annual hospice rates established under Medicare. Therefore, the Medicaid FY 2016 changes reflect the updates found in The FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements final rule. As authorized under the Affordable Care Act, the market basket update is decreased by 2 percentage points for any hospice provider that does not comply with the quality data submission requirements and this penalty extends to minimum Medicaid rates. The payment data CMS presents includes two sets of payment, one for providers who have complied with the required quality reporting and one with a penalty for failure to comply.
The first of two changes to become effective as of Jan. 1st implements the change in payment methodology that results in a higher base payment for the first 60 days of hospice care and a reduced base payment rate for days thereafter.
The second methodology change effective Jan. 1st provides for SIA payment for a visit by a social worker or a registered nurse (RN), when provided during routine home care in the last seven days of life. The SIA payment is in addition to the routine home care rate. The SIA payment is equal to the Continuous Home Care hourly rate multiplied by the hours of nursing or social work provided (up to 4 hours total) on the day of service. The SIA payment will also be adjusted by the appropriate wage index.
Please refer to the CMS memo for more details and a breakdown of the rate data.
Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827