MLN Matters® Number: MM6606
Related Change Request (CR) #: 6606
Related CR Release Date: August 14, 2009
Effective Date: October 1, 2009
Related CR Transmittal #: R1796CP
Implementation Date: October 5, 2009
Provider Types Affected
Hospice providers submitting claims to Medicare contractors (Fiscal Intermediaries (FIs), Part A/B Medicare Administrative Contractors (A/B MACs), and/or Regional Home Health Intermediaries (RHHIs)) for services provided to Medicare beneficiaries.
What You Need to Know
This article is based on Change Request (CR) 6606 which provides the annual update to the hospice payment rates for FY 2010, the hospice aggregate cap amount for the cap period ending October 31, 2009, and the hospice wage index and Pricer for FY 2010. Be sure your billing staffs are aware of these changes, which are described in the Background section, below.
Background
The Centers for Medicare & Medicaid Services (CMS) updates the payment for hospice care, the hospice aggregate cap amount, and the hospice wage index annually.
- The Social Security Act (Section 1814(i)(1)(C)(ii)) (the Act) stipulates that the payments for hospice care for fiscal years after 2002 will increase by the market basket percentage increase for that fiscal year (FY), and this payment methodology has been codified in the Code of Federal Regulations (Title 42, Section 418.306 (a)&(b)).
- You can review the Social Security Act, Section 1814(i)(1)(C)(ii) at www.ssa.gov/OP_Home/ssact/title18/1814.htm, and 42CFR418.306(a)&(b) at http://edocket.access.gpo.gov/cfr_2006/octqtr/pdf/42cfr418.306.pdf (PDF, 49 KB) on the Internet.
- The Hospice Aggregate Cap amount is updated annually. Specifically, the cap amount is increased or decreased for accounting years after 1984 by the same percentage as the percentage increase or decrease (respectively) in the medical care expenditure category of the Consumer Price Index for all Urban Consumers.
- The Hospice Wage Index, used to adjust payment rates to reflect local differences in wages according to the revised wage index, is updated annually in accordance with recommendations made by a negotiated rulemaking advisory committee as published in the Federal Register on August 8, 1997 (see http://bulk.resource.org/gpo.gov/register/1997/1997_42883.pdf (PDF, 10.9 KB) on the Internet and on August 8, 2008 (see http://edocket.access.gpo.gov/2008/pdf/E8-17795.pdf (PDF, 384 KB) on the Internet); and the Code of Federal Regulations (42 CFR 418.306(c)) requires that the updated hospice wage index be published annually in the Federal Register (see http://edocket.access.gpo.gov/cfr_2006/octqtr/pdf/42cfr418.306.pdf (PDF, 49 KB) on the Internet.)
The annual hospice payment updates will be implemented through the Hospice Pricer software. The new Pricer module will not contain any new calculation logic, but will simply apply the existing calculation to the updated payment rates shown below. An updated table will be installed in the module, to reflect the FY 2010 hospice wage index.
FY 2010 Hospice Payment Rates
The FY 2010 payment rates will be the FY 2009 payment rates, increased by 2.1 percentage points, which is the total hospital market basket percentage increase forecasted for FY 2010. The FY 2010 hospice payment rates are shown in the following table and are effective for care and services furnished on or after October 1, 2009 through September 30, 2010.
|
Code
|
Description
|
Rate
|
Wage Component
Subject to Index
|
Non-Weighted
Amount
|
|
651
|
Routine Home Care |
$142.91
|
$ 98.19
|
$ 44.72
|
|
652
|
Continuous Home Care
Full Rate = 24 hours of care
$34.75= hourly rate |
$834.10
|
$573.11
|
$260.99
|
|
655
|
Inpatient Respite Care |
$147.83
|
$ 80.02
|
$ 67.81
|
|
656
|
General Inpatient Care |
$635.74
|
$406.94
|
$228.80
|
Reference to the hospice payment rate is discussed further in the Medicare Claims Processing Manual, Chapter 11 (Processing Hospice Claims), Section 30.2 (Payment Rates); see www.cms.hhs.gov/manuals/downloads/clm104c11.pdf (PDF, 270 KB) on the CMS Web site.
Hospice Cap
The latest hospice cap amount for the cap year ending October 31, 2009 is $23,014.50. In computing the cap, CMS used the medical care expenditure category of the March 2009 Consumer Price Index for all Urban consumers, published by the Bureau of Labor Statistics (www.bls.gov/cpi/home.htm), which was 373.189. The hospice cap is discussed further in the Medicare Claims Processing Manual, Chapter 11 (Processing Hospice Claims), Section 80.2 (Cap on Overall Hospice Reimbursement); see www.cms.hhs.gov/manuals/downloads/clm104c11.pdf (PDF, 270 KB) on the CMS Web site.
Hospice Wage Index
The Hospice Wage Index final rule will be effective October 1, 2009 and the final rule for the 2010 Hospice Wage Index is available at http://edocket.access.gpo.gov/2009/pdf/E9-18553.pdf (PDF, 2.92 KB) on the Internet. The revised wage index and payment rates will be incorporated in the hospice Pricer and forwarded to the intermediaries following publication of the wage index final rule.
Important Reminder: Hospice providers are encouraged to split claims when the dates of service span separate fiscal years, e.g., claims with September and October services. This allows Medicare systems to price the September services at the FY2009 rates and the October services at the FY2010 rates. If you do not split such claims, all the services will be paid using the FY2009 rates and your Medicare contractor will not perform subsequent adjustments for such claims paid totally at the 2009 rates.
Additional Information
You can find the official instruction, CR6606, issued to your FI, A/B MAC, or RHHI by visiting www.cms.hhs.gov/Transmittals/downloads/R1796CP.pdf (PDF, 155 KB) on the CMS Web site.
If you have any questions, please contact our provider service center at our toll-free number, (866) 801-5301.
Disclaimer: This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
last updated on 08/20/2009