On July 31, 2020, the U.S. Centers for Medicare & Medicaid Services (“CMS”) released the final FY2021 hospice payment rule (“Rule”). The national hospice payment rates, subject to geographical application, and the hospice CAP will increase by 2.4% over the current payment rates. Additionally, the Rule establishes modifications to the hospice election statement and requires hospice to offer an “Election Statement Addendum” containing information about noncovered diagnoses, services, and treatment that will not be covered by the hospice inasmuch as they are considered to be unrelated to the principal diagnosis and related conditions.
National rates, subject to geographical modification are as follows:
Description Current Rate Updated Rate
Routine home care (days 1-60) $ 194.50/day $ 199.25/day
Routine home care (days 61+) $ 153.72/day $ 157.49/day
Continuous home care $ 58.15/hour $ 59.68/hour
Inpatient respite care $ 450.10/day $ 461.09/day
General inpatient care $1,021.25/day $1,045.66/day
2018 cost report submissions were not used to modify rates even though 2017 cost reports were used to establish the modified payment rates.
Service intensity adjustment payments are set at the continuous home care rate of $59.68/hour.
The aggregate payment limitation (“CAP”) is set at $30,683.93 for the 2020-2021 year, which ends on September 30, 2021. The CAP is applied nationally without any geographical consideration.
The election statement changes, and the required Election Statement Addendum are required for hospice elections beginning on and after October 1, 2020. Remember, the signed addendum, and any signed updates, are a new condition for payment.
The final rule is available here. The Model Election Statement and Addendum are available here.
COMPLIMENTARY WEBINAR – CONSOLIDATION IN HOME HEALTH & HOSPICE: KEY TRANSACTIONAL CONSIDERATIONS
Since the mid 2000’s, the home health and hospice sectors have seen an influx of M&A activity driven by both private equity firms and strategic consolidators. There has been a significant increase in M&A activity in recent years as financial sponsors continue to compete for attractive assets and strategic consolidators seek to expand service offerings in a growing attempt to capture the entire continuum of care. This webinar will include insight from Provident Healthcare Partners investment bankers, Kevin Palamara and Jake Vesely, as well as industry consultant, Ted Cuppett, The Health Group, LLC, who have been active in guiding home health and hospice organizations through merger and acquisition transaction processes and related consulting services. Each professional will draw upon the knowledge gained from being at the forefront of consolidation across healthcare.
The one-hour webinar is Thursday, August 13, 2020 at 1:00 P.M. EST. Register here.