CMS Proposed Rule Could Decrease Hospice Reimbursement


In its proposed rule for Fiscal Year 2020, the Centers for Medicare and Medicaid Services (CMS) has suggested rate increases to agencies for the provision of Continuous Home Care (CHC), General Inpatient Care (GIP), and Inpatient Respite Care (IRC). These increases are proposed to help hospice agencies offset the cost of care provision on these levels of care. According to CMS, these rate increases are projected to lead to an increase in reimbursement to hospice agencies totaling $540 Million in 2020. However, due to regulations in the Affordable Care Act of 2010, all proposed changes in reimbursement must be done in a budget neutral manner.  

Routine Home Care Reimbursements Cut 

To account for these increases, CMS has also proposed a 2.7% reduction in reimbursement for Routine Home Care (RHC), which accounts for 98.2% of total hospice days in FY2018. According to CMS, continuous home care accounted for 0.2% of total hospice days, general inpatient care for 1.3%, and inpatient respite care for 0.3%. While hospices must provide all four levels of care as a condition of participation, only a small fraction of care is provided outside of routine home care. As a result, hospice organizations that provide low rates of these levels of care are at risk of losing about $1 per day per patient if the proposed rules become final, while those who provide higher amounts of CHC, GIP and IRC care stand to see increases in 2020.  

The National Hospice and Palliative Care Organization (NHPCO) released a statement opposing the proposed cuts to Routine Home Care rates, stating the reductions “will hurt hospice organizations and their ability to provide care.” 

Steps to Ensure Quality of Life 

Agencies can employ a few of the following strategies to ensure they continue to improve the quality of life of patients and families while protecting their hard-earned revenues: 

  • Ensure nurses are educated on accurate assessment of patients requiring CHC, GIP and IRC care 
  • Ensure your EMR software allows clear documentation of assessed needs 
  • Provide adequate support from all members of the Interdisciplinary Team in the last seven days of life 
  • Capture Registered Nurse and Medical Social Work visits on your Final Claims for Service-Intensity Add-on (SIA) Payments when patients are on Routine Home Care. 

The hospice industry is accustomed to the ever-changing landscape of regulations and is uniquely suited to adapt to new standards. Axxess is committed to evolving with the industry by providing expert guidance and compliant software solutions. While changes to our reimbursement can negatively impact the industry, we will continue to adapt to ensure quality, patient-centered care for every patient.