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Volume 20.08

The U.S. Centers for Medicare & Medicaid Services (“CMS”) has released the proposed 2021 Hospice Wage Index and Payment Rate Update, which is scheduled for publication in the Federal Register on April 15, 2020.

This proposed rule would update the hospice wage index, payment rates, and CAP amount for fiscal year (FY) 2021. This rule also proposes changes to the hospice wage index by adopting the most recent Office of Management and Budget statistical area delineations, with a 5 percent CAP on wage index decreases. Finally, this proposed rule summarizes the changes to the hospice election statement finalized in the FY 2020 Hospice Wage Index and Rate Update final rule and effective for October 1, 2020 and provides hospices with a model election statement and sample addendum.  Comments must be received by June 9, 2020.

Proposed, pre-wage adjusted 2021 hospice payment rates are:

Routine home care (days 1-60)      $    199.34
Routine home care (days 61+)       $    157.56
Continuous home care (hourly)    $    59.61
Inpatient respite care                      $    461.48
General inpatient care                    $  1,046.55

While the 2020 rates were adjusted based on cost report submissions, there was no attempt in the proposed rule to further review costs as reported in the subsequent cost report filings for establishing the proposed 2021 rates.

Changes have been made to geographical designations.  Accordingly, hospices should review the updated wage index in estimating 2021 reimbursement rates.

The 2021 proposed hospice CAP is $30,743.86.

CMS has not proposed any changes regarding the election statement content modifications of the requirements for the election statement addendum.  The finalized policies are effective for hospice elections beginning on and after October 1, 2020.

The proposed rule is available here.  The wage index and Model Hospice Election Statement and Addendum are available here.


Many hospices applied for and received accelerated payments.  Additionally, hospices received a special one-time grant as a result of CARES and some hospices have applied for loans through the SBA guaranteed program.  The Health Group, LLC is in the process of preparing guidance on accounting for tracking use of these funds.  This will be available once completed and notification will be made in future Alerts.