Situation Report | October 4, 2021
Last week, the U.S. Centers for Medicare and Medicaid Services (CMS) announced the release of the Medicaid hospice payment rates for Federal Fiscal Year (FFY) 2022. The rates reflect changes made under the final Medicare hospice rule published on August 4, 2021 (CMS-1754).
CMS has informed all state agencies of these new payment rates, which are effective October 1, 2021. CMS expects state agencies, such as the New York State Department of Health (DOH) to share the Medicaid hospice payment rates for FY 2022 with the hospice providers in their states in the near future.
The Medicaid hospice payment rates are calculated based on the annual hospice rates established under Medicare. These rates are authorized by section 1814 of the Social Security Act, which also provides for an annual increase in payment rates for hospice care services. This annual increase was 2.0 percent for FY 2022.
Additionally, Section 3004 of the Affordable Care Act (ACA) amended the Act to authorize a Medicare quality reporting program for hospices and allows the Secretary to reduce the market basket update by 2 percentage points for any hospice provider that does not comply with the quality data submission requirements with respect to that FY. CMS notes that the Medicaid minimum rates would be reduced by the amount of any penalty due to non-reporting.
The following table includes the Medicaid hospice rates in FY 2022 for hospice providers that have complied with the quality reporting requirements. The Medicaid hospice payment rates for: Routine Home Care (including the service intensity add-on), Continuous Home Care, Inpatient Respite Care, and General Inpatient Care will be in effect for all of FY 2022 and are as follows:
FY 2022 Hospice Medicaid Payment Rates
|Type of Hospice Service||FY 2022 Medicaid Payment Rate||Labor Portion Subject to Wage Index|
|Routine Home Care (Days 1-60||$203.66||$134.42|
|Routine Home Care (Days 61 Plus||$160.95||$106.23|
|Continuous Home Care (Full Rate = 24 Hours)||$1,463.09 ($60.96 Hourly Rate)||$1100.24|
|Inpatient Respite Care||$498.68||$304.20|
|General Inpatient Care (GIP)||$1,068.28||$678.36|
As mentioned previously, hospices that failed to meet the quality reporting requirements will see a 2 percentage point reduction in their payment rates. The labor portion of these rates must be further adjusted by the hospice specific wage index. The hospice Aggregate Cap for the year ending September 30, 2022 is $31,297.61.