Medicaid Payment Rates

Originally published by Jerri Lynn Ward, J.D..

Medicaid Payment Rates

As you know, the CMS Medicaid hospice payment rates memo was released on September 1, 2015. The

requirements reflect the Medicare final rule which was published on August 6, 2015. The rule changes

implement several items:

? Payment methodology for routine home care (RHC) – beginning January 1, 2016 the RHC rates

will be implemented; a higher base payment for the first 60 days of care and a reduced rate for

the days thereafter.

? Service Intensity Add-on – this is payment for services provided by a registered nurse or social

worker for up to four hours during the last seven days of a recipient’s life. This payment is in

addition to the RHC. Payment is equal to the continuous home care hourly rate multiplied by the

hours of nursing or social work provided that occurred on the day of service. The service

intensity add-on will be reviewed and paid after by the fiscal intermediary.

? The hospice rates provide for an annual increase.

? The hospice cap amount for Federal Fiscal Year 2016 is $27,820.75.

? Quality reporting will continue. If the provider does not complete the quality data report the

payment rate will be decreased by two percentage points.

The post Medicaid Payment Rates appeared first on Garlo Ward, P.C..

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