Hospice Payment Rates

In a Memorandum to Associate Regional Administrators in the Division of Medicaid dated September 1, 2015, the Center for Medicaid and CHIP Services Financial Management Group has issued notice of the minimum Medicaid Hospice payment rates that will be effective for Fiscal Year (FY) 2016.  By law Medicaid hospice payments are calculated using Medicare rates for the applicable time period, although there are minor differences in the payment rates.  States have the flexibility to pay hospice programs higher rates than these minimums set by CMS. 

As under Medicare, Medicaid hospices will be paid a single rate ($162.10) for Routine Home Care (RHC) days from October 1 through December 31, 2015, after which RHC will be paid at one of two rates depending on where the day of care falls in the patient’s episode of care (days 1 – 60 and day 61 or later).  Beginning January 1, 2016, Medicaid hospice programs will also provide payment for the Service Intensity Add-on (SIA). Please note that Medicaid hospice providers are subject to the Hospice Quality Reporting Program (HQRP) requirements, so failure to submit the applicable quality data will result in a 2 percentage point reduction in the hospice’s market basket update.