CMS Issues FY 2021 Hospice Medicare and Medicaid Base Rates

Situation Report | September 21, 2020

The U.S. Centers for Medicare and Medicaid Services (CMS) announced last week a 2.4 percent increase in the hospice base payment rates, beginning October 1, 2020, as published in the final Fiscal Year (FY) 2021 Hospice Payment Rule.

As is customary, the Medicaid program waits until Medicare rates are finalized to issue guidance on the applicable corresponding hospice payment rates. CMS’s Medicaid Financial Management Group recently issued a memo containing the minimum Medicaid hospice rates that will be applicable for FY 2021.

Hospices should note that Continuous Home Care is the rate applicable to the Service-Intensity Add-on (SIA) for certain in-person visit hours delivered by RNs and Social Workers in the last week of life while a patient is on Routine Home Care (RHC). The Continuous Home Care rate is $59.68 under Medicare and $59.71 for Medicaid.

Medicare and Medicaid rates vary slightly due to the consideration of potential copayments that are included when calculating the Medicare rates but not those for Medicaid.

Recently, CMS also issued Transmittal 10338 with further payment details. It provides a breakdown of the labor and non-labor portion of the rates for use when applying the wage index. It also explains how rates are affected by failure to meet quality reporting requirements.

The table below contains a comparison of the FY 2021 Medicare and Medicaid rates. The labor portion of these rates must be further adjusted by the wage index.

The hospice Aggregate Cap for the year ending September 30, 2021 is $30,683.93.

Type of Hospice ServiceFY 2021 Medicare Payment RateFY 2021 Medicaid Payment Rate
Routine Home Care (Days 1-60)$199.25$199.51
Routine Home Care (Days 61 Plus)$157.49$157.69
Continuous Home Care
(Full Rate=24 Hours)
($59.68 Hourly Rate)
($59.71 Hourly Rate)
Inpatient Respite Care$461.09$485.36
General Inpatient Care (GIP)$1,045.66$1,045.66

Hospices that failed to meet the quality reporting requirements will see a 2 percentage point reduction in their payment rates.

Lastly, our colleagues at the National Association for Home Care and Hospice (NAHC) have clarified with CMS that the value for the Continuous Home Care Daily rate in Change Request 11867 (issued August 27) is incorrect. The correct amount is $59.68 (not $59.74).