Hospice Final Rule 2016

Hospice continues to see reimbursement levels increase.  For fiscal year 2016 (October 1, 2015 – September 30, 2016), hospice providers are going to be receiving an additional $160 million in reimbursement.  The increase in reimbursement has to do with the annual payment update, using wage index data and new CBSA designations.


Reimbursement will be slightly modified to provide different levels, based on the services provided to patients. Routine home care, based on the length of stay, will be one type of reimbursement.   The first 60 days of service will result in a higher base payment beginning on January 1, 2016.  Day 61 and later will receive a reduced payment for services except for those in the last 7 days of life.


For patients in the last 7 days of life, a service intensity payment add-on will be provided, should the patient needs meet Medicare guidelines.  Service intensity payments will be included for patients that meet the criteria and reside in a skilled nursing facility.


The hospice aggregate cap is also being realigned to match with fiscal year 2017.  The cap alignment is a result of the Impact Act.  Clinically, all diagnoses, whether or not related to the patient’s terminal prognosis, must be reported.