Hospice Routine Home Care Level of Care Payment Reform and Service Intensity Add-On Visit Payment Q&As Updated
March 16, 2016 12:20 PM
Medicare hospice payment reforms went into effect January 1, 2016. To assist providers, NAHC developed a Q&A document on these reforms – routine home care (RHC) level of care payment reforms and service intensity add-on (SIA) payments. The document has been updated and can be viewed here.
The Medicare Program; FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements (Final Rule) was published in the Federal Register on August 6, 2015. This Final Rule implements two significant reforms to Medicare hospice payments:
Imposition of a two-tiered payment system for the routine home care (RHC) level of care; payment level is based on a beneficiary’s hospice episode days
Creation of a service intensity add-on (SIA) payment for Registered Nurse (RN) and Social Work (SW) visits made in the last seven days of a beneficiary’s life if certain conditions are met. Those conditions are:
The day is a RHC level of care day;
The day occurs during the last 7 days of life (and the beneficiary is discharged dead); and,
Direct patient care is provided by a RN or a social worker
Subsequent to the release of the Final Rule, CMS issued three change requests (CR) instructing Medicare Administrative Contractors (MACs) how to process the RHC level of care payments and the SIA payments. The change requests are:
CR 9201 Implementation of Hospice Payment Reforms NAHC Report Coverage: August 21, 2015
CR 9301 Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for FY 2016 NAHC Report Coverage: September 10, 2015
CR 9369 Additional G-Codes Differentiating RNs and LPNs in the Home Health and Hospice Setting NAHC Report Coverage: October 20, 2015
NAHC has updated its Q&A document, as linked in the first paragraph, to answer various questions to assist providers with these reforms.