Medicare & Medicaid to Pay Hospices $160 Million More in 2016

Last week, The Centers for Medicare & Medicaid Services (CMS) published a final rule that will change the way hospices are paid in 2016. In the final rule announced in Federal Register, 80 Fed. Reg. 47142, hospices will receive approximate $160 million more in payment over the 2016 fiscal year.

As AHLA Weekly reports, the increase represents a 1.1% bump from 2015 and is dictated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (or the IMPACT Act). The IMPACT Act "mandates that the hospice aggregate cap be updated by the hospice payment update percentage, rather than using the CPI-U, for a specified time." The CMS change, therefore, will allow for a timely aligning of new inpatient and hospice aggregate caps for 2017 and beyond-as dictated by the Act.

The new rule also creates new payment rates for routine home care, effective January 1, 2016:

  • A higher base payment for the first 60 days of hospice treatment
  • A lower base payment for 61 or more days of hospice care

Additionally, the rule also provides a new eligibility for a Service Intensity Add-On (SIA) Payment in 2016. As the CMS states, if patients meet certain criteria, the payment will be made to hospices in the last seven days of the patient's life, "when more resource-intensive days typically occur."

Needed Vigilance by Healthcare Providers

As with any changes to Medicare and Medicaid policy, healthcare and hospice service providers need to remain vigilant about the effective dates of these changes and ensure they act accordingly. Not only can a failure to do so mean missing out on funds and resources to better run their business and serve patients, but can even result in violations that could affect their standing with these programs.

The Law Offices of Alejandro Mora, PLLC is a premier Texas law firm dedicated solely to healthcare law. Attorney Mora provides both initial and ongoing counsel for healthcare providers and medical professionals all over the state. He ensures that they always proceed with a current and informed approach and, if a complication occurs, that their rights are aggressively protected against legal or administrative action.

Put your case in the hands of an experienced Texas healthcare attorney. Contact the firm today.

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