CMS Moves Forward With Major Hospice Payment Change

A major change in the way hospice providers are reimbursed will indeed go into effect, but not as quickly as originally proposed, the Centers for Medicare & Medicaid Services (CMS) announced in a final rule issued Friday.

Currently, Medicare-certified providers receive a per-day reimbursement of about $160 for patients in routine home care (RHC). Under the new policy, hospices will receive about $185 a day for RHC during the first 60 days, then about $145 starting on day 61.

CMS originally proposed starting those tiered payments on Oct. 1, 2015, but now will not institute them until Jan. 1, 2016. This is to enable enough time for needed systems and software changes, the final rule states.


In another change, service intensity add-on (SIA) payments will be made even for hospice patients residing in a nursing or skilled nursing facility during their last week of life. These payments will be for direct patient care given during that period by registered nurses or social workers.

The National Association for Home Care & Hospice (NAHC), among others, expressed concern that the payments would not be available in the institutional settings.

The final rule also sets an overall payment update of 1.1%, meaning hospices will see an estimated $160 million increase in Medicare reimbursements in fiscal year 2016. That’s down from the $200 million total increase in the proposed rule.


CMS also revised downward the total Medicare payment increase for skilled nursing facilities next year, in a separate final rule. That change was based on updated economic data since the proposed rule was released.

Written by Tim Mullaney

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