September 9, 2015

Medicare Hospice Final Payment Rules Effective October 1, 2015

Medicare Hospice Final Payment Rules Effective October 1, 2015

The Medicare hospice final rules for services beginning October 1, 2015 were issued in the August 6, 2015 Federal Register. The primary change from the proposed rules was a rate reduction ranging from 0.35% to 0.72%. The final rule was consistent with the proposed rule for key provisions most notably:

  • Two tier reimbursement for routine services provided after December 31, 2015 based on the beneficiary�s length of stay
  • Implementation of a service intensity add-on “SIA” payment for services provided in the last 7 days of a beneficiary�s life

This final rule updates the payment rates for hospices for fiscal year (FY) 2016, as required under section 1814(i) of the Social Security Act (the Act) and reflects the final year of the 7-year Budget Neutrality Adjustment Factor (BNAF) phase-out finalized in the FY 2010 Hospice Wage Index final rule.

In addition, this rule will implement changes to the aggregate cap calculation mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), align the cap accounting year for both the inpatient cap and the hospice aggregate cap with the federal fiscal year starting in FY 2017, make changes to the hospice quality reporting program, clarify a requirement for diagnosis reporting on the hospice claim, and discuss recent hospice payment reform research and analyses.

Source: CMS

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