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Hospice Center

  • The Centers for Medicare & Medicaid Services (CMS) issued a final rule CMS-1629-F to update the Medicare hospice payment rates and wage index ( Final FY 2016 Hospice Wage Index [ZIP, 269KB] ) for fiscal year (FY) 2016. The final rule reflects the ongoing efforts of CMS to support beneficiary access to hospice care.  Hospices serving Medicare beneficiaries would see an estimated increase in payments of 1.1 percent ($160 million) for FY 2016. CMS is finalizing two routine home care rates, in a budget-neutral manner, to provide separate payment rates for the first 60 days of care and care beyond 60 days. In addition to the two routine home care rates, CMS is finalizing a service intensity add-on payment that would help to promote and compensate for the provision of skilled visits at end of life.  These two new policies will be effective beginning on January 1, 2016.

  • This is to notify all Medicare Part D plans and Medicare Hospice Providers that on October 3, 2014, the Centers for Medicare & Medicaid Services (CMS) announced an opportunity to comment on CMS-10538 (Prior Authorization Form for Beneficiaries Enrolled in Hospice).  In response to CMS’ recent guidance, industry commenters recommended that we require the use of a standard PA form to facilitate coordination between Part D sponsors, hospices and prescribers. The industry, in conjunction with the National Council for Prescription Drug Programs, (NCPDP) has developed a standard form that with minor modifications will meet the program needs. The revised format is now published in accordance with the Paperwork Reduction Act (PRA) requirements.

    To view the PRA notice and instructions for submitted comments please see  To view the draft form and supporting documents please visit The comment period ends at midnight on December 2, 2014.

  • On July 18, 2014, the Centers for Medicare & Medicaid Services (CMS) issued, “Part D Payment for Drugs for Beneficiaries Enrolled in Medicare Hospice”, a memorandum to Part D sponsors and Medicare Hospices to modify the March 10, 2014 guidance to Part D sponsors to place a prior authorization for all drugs for hospice beneficiaries.  The revised guidance expects Part D sponsors to use hospice prior authorization only on the four categories of drugs that the Office of Inspector General (, in consultation with hospice providers, identified as nearly always covered under the hospice benefit.  These categories of drugs will require hospice prior authorization are analgesics, antinauseants, laxatives, and antianxiety drugs.  Hospices may use the “Hospice Information for Medicare Part D” form to provide the necessary information generally requested by Medicare Part D sponsors.
  • On May 1, 2014, CMS issued CR 8727, entitled “Updates and Clarifications to the Hospice Policy Chapter of the Benefit Policy Manual,” which will be effective August 4, 2014. This CR updates the hospice policy chapter of the Internet Only Manual (IOM 100-02, chapter 9) to incorporate policy language from existing regulations, prior rules, an Office of Inspector General Memorandum Report, and two Change Requests, and to clarify existing policy. No changes were made to existing policies.
  • The Centers for Medicare & Medicaid Services recently launched an initiative to develop innovative payment systems to improve care options for beneficiaries by allowing greater beneficiary access to comfort and rehabilitative care in Medicare and Medicaid.  The Medicare Care Choices Model provides a new option for Medicare beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS who meet hospice eligibility requirements under the Medicare hospice benefit, to receive palliative care services from certain hospice providers while concurrently receiving services provided by their curative care providers.  The Medicare Care Choices Model will test improvements to certain Medicare beneficiaries’ quality of life while they are receiving both curative and palliative care.  Eligible hospice organizations interested in participating in this model must submit application materials no later than June 19, 2014. For application materials and additional information, please visit the Medicare Care Choices Model web page.
  • Hospice providers should ensure that their information on the hospice list is current and complete.  Please submit any required changes electronically to PECOS at: .

  • CR 8358 entitled “Additional Data Reporting Requirements for Hospice Claims”  was revised on January 31, 2014 to provide clarifying information and examples in the policy section, and to make technical corrections to remove references to legacy contractors in the Business Requirements Table and Funding sections, and to make technical corrections to the manual text. All other information remains the same.  

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