As expected from the 2015 rule issued by the Centers for Medicare and Medicaid Services (CMS-1629-F), the time frame for computing the hospice cap is now changing. The purpose of this change is to better align the hospice cap period with payment rates, which run from October 1st of a given year to September 30th of the following year. This change was published in the Fiscal Year 2016 Hospice Payment Update issued on August 6, 2015.
Current Structure:
Due Date for Self-Determined Hospice Aggregate Cap Year 2017:
Beneficiary Count Dates Cap Year 2017:
- Proportional (Fully Pro-Rated) 11/01/16 - 09/30/17 (11 months)
- Streamlined - 09/28/16 - 09/30/17 (12 months and three days)
Payment Dates:
- Proportional (Fully Pro-Rated) 11/01/16 - 09/30/17 (11 months)
- Streamlined - 11/01/16 - 09/30/17 (11 months)
2017 Hospice Cap Amount:
- $28,404.99 Based on 12 months
Beginning in 2017, the time frame for computing the hospice cap will end on September 30th. Previously, the period for computing the hospice cap ended on October 31st. Cap Year 2017 is a transition year.
New Structure:
Due Date for Self-Determined Hospice Aggregate Cap Year 2018:
Beneficiary Count Dates Cap Year 2018 and Later:
- Proportional (Fully Pro-Rated) 10/01/17 - 09/30/18 (12 months)
- Streamlined - 10/01/17 - 09/30/18 (12 months)
Payment Dates:
- Proportional 10/01/17 - 09/30/18 (12 months)
- Streamlined - 10/01/17 - 09/30/18 (12 months)
The chart below illustrated the shifts in all timelines:
Click here to view the final rule.
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