Hospice Payment Reform Update

Monday, July 1, 2019

Due to the implementation of Centers for Medicare and Medicaid Services (CMS) FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements Final Rule, NC Medicaid made policy and system changes to allow for the use of two-tier hospice fee schedules effective Jan. 1, 2016. Hospice payment reform implemented the use of two Routine Home Care (RHC) rates based on days of hospice service and a Service Intensity Add-on (SIA) payment for services provided during the last seven days of life.

On Nov. 1, 2017, NCTracks system changes were implemented and all claims for hospice service began to be reimbursed in accordance with the requirements of hospice payment reform. NC Medicaid has since requested system updates to CSRA’s previous implementation of the routine home care reform components.

NC Medicaid continues to work with hospice stakeholders to finalize the details of the phase-in approach that will be used to reprocess claims for services provided from Jan. 1, 2016 forward. Providers will not be required to take any action. The affected claims will be systematically reprocessed as adjustments to apply the revised rates. A claims reprocessing notice will be sent to the NCTracks message center inbox of affected providers before the reprocessing occurs.

Medicaid Long-Term Services and Supports, 919-855-4340