The purpose of this information letter is to inform Medicaid Hospice providers of the addition of a service intensity add-on (SIA) payment authorized under the “FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements” published August 6, 2015. CMS implemented payments to reflect changes in resource intensity in the provision of care and services during the course of hospice care.
Beginning January 1, 2016, an SIA payment may be billed in addition to the per diem rate for routine home care (RHC) level of care and is equal to the continuous home care (CHC) hourly rate if the following requirements are met:
• The day is an RHC level of care day.
• The care occurs during the last seven days of an individual’s life who is receiving
Medicaid-only hospice services and the individual has died.
• The skilled service is provided by a registered nurse (RN) or medical social worker (SW) for at
least 15 minutes but no more than four hours per day:
o RN and SW hours are combined and cannot exceed four hours total; o RN and SW hours provided concurrently count separately;
o RN and SW hours can occur over multiple visits per day;
o the service is provided in person; and
o the skilled service provided is clearly documented.
The SIA payment will be determined by the number of hours, in 15-minute increments, of service provided multiplied by the hospice provider’s current CHC hourly rate.
The CHC hourly rate for Hospice A is equal to $33.00 per hour. If an RN spends 45 minutes in the morning assessing an individual who is at the end of life, and the SW spends 45 minutes in the afternoon assisting the family with grieving, a total of 1.5 hours was spent in person providing skilled services:
1.5 total hours multiplied by $33.00 per hour equals $49.50 additional SIA payment that can be billed by Hospice A for the day.
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