Hospice rates are calculated based on the annual hospice rates established under Medicare. These rates are authorized by section 1814(i)(1)(C)(ii) of the Social Security Act which also provides for an annual increase in payment rates for hospice care services. Rates for hospice physician services are not increased under this provision.
RHC Tiered Rate Structure
Federal Rule 42 CFR Part 418, CMS–1629–F, RIN 0938–AS39 Medicare Program; FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements establishes an updated reimbursement rate of differential payments for routine home care (RHC) based on the beneficiary’s length of stay, and implements a service intensity add-on (SIA) payment for services provided by a Registered Nurse or social worker in the last 7 days of a beneficiary’s life for at least 15 minutes and up to 4 hours total per day.
Fee-For-Service Rates Development Division (FFSRDD) has posted Medi-Cal reimbursement rates in anticipation of DHCS/CA-MMIS ability to reimburse in accordance with the new rate structure; however the capability does not currently exist. DHCS/CA-MMIS is working with Xerox to develop a solution to reimburse providers according to the new methodology. This effort is ongoing and there is no projected implementation date at this point in the project. Current reimbursement rates effective October 01, 2015 to December 31, 2015, will remain in place until further notice.
Please note: SDN13017 Hospice Local Code Conversion will not be affected by this policy.
Note: For 2016-2017, CMS has implemented a ‘tiered’ rate structure for Routine Home Care (RHC). At this time, DHCS/CAMMIS does not have the solution in place to allow for this structure. The current billing code for RHC will remain as-is and the rate will be unchanged. Only Continuous Care, Inpatient Respite Care and General Inpatient Care have been updated.
- 2015.16 Hospice Rates, effective October 1, 2015 (PDF)
- 2015HospiceRates for RHC and New SIA Effective 10-01-15 and 01-01-16.pdf
- 2014.15 Hospice Rates, effective October 1, 2014, updated 2.24.15 (PDF)
If you're interested in hospice rates effective prior to October 2010, please contact the Long Term Care Reimbursement Unit at (916) 552-9600.
Return to Long Term Care Reimbursement Index