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Home Health Medicare News: CMS Proposes $200 Million Increase In Hospice Pay

Posted by Nathan Hope on May 4, 2015

Home Health Medicare News- In a new proposal by CMS, Medicare-certified hospices could potentially see a nearly $200 million increase to their 2016 fiscal year payments. The proposed rule would affect routine home care and would result in a higher rate of base payment for the first 60 days of hospice care. In addition to the routine home care rate increases, the proposal also includes a Service Intensity Add-On (SIA) payment.

In a statement, a CMS representative remarked, “These differing payment rates would further the goal of more accurately aligning the per diem payments with visit intensity and the cost of providing care”. Regarding the SIA payment, CMS stated, “The proposed SIA payment is a payment that would be made for the last seven days of life in addition to the per diem rate for the Routine Home Care (RHC) level of care if certain criteria were met,” CMS says.14-06-11-nurse-patient

The SIA payments will not be made to providers with patients receiving SNF/NF services, which the National Association for Home Care and Hospice (NAHC) opposes.

“We are taking a particularly close look at CMS’ proposed service intensity add-on (SIA) that is intended to support the very resource-intensive care provided to patients and families at the end of life,” says said Denise Schrader, chair of the NAHC Board of Directors. “While we appreciate CMS’ efforts to address this issue, we have concerns about the adequacy of this add-on, and further concerns that CMS would not allow this adjustment for patients residing in nursing facilities.”

The proposed rule also gives clarification to the issues regarding diagnoses on claim forms. The rule requires hospices to report any diagnoses that were recorded on the initial comprehensive assessments for hospice claims, regardless of whether they are related to the terminal prognosis of the patient. “Based on the numerous comments received in previous rulemaking, and anecdotal reports from hospices, hospice beneficiaries, and non-hospice providers, we are concerned that some hospices are neither conducting a comprehensive assessment nor updating the plan of care as articulated by the Conditions of Participation to recognize the conditions that affect an individual’s terminal prognosis”.

The full proposal can be viewed in full here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-10422.pdf


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