Eli's Hospice Insider

Published on Tue Apr 21, 2009 PDF

CMS releases 2009 cap amount early.

If you're wondering whether you'll have trouble with exceeding the per beneficiary cap this year, you shouldn't have to wonder much longer.

The Centers for Medicare & Medicaid Services issued the 2009 cap amount early "to assist the hospice industry in planning and budgeting," it says on its Web site. The cap amount is $23,014.50.

CMS also includes its methodology for the cap calculation "so that hospices can compute the amount themselves in the future if they so desire."

That calculation methodology could be changing, however. In its proposed rule in the April 24 Federal Register, CMS floats the idea of revamping how it determines the cap amount.

"Until recently, hospices rarely exceeded the aggregate cap," CMS notes in the rule. But now hospices have more patients with longer lengths of stay and exceed the cap more often.

The Medicare Payment Advisory Commission "found that for-profit ownership, smaller patient loads, and being a freestanding facility were correlated with longer lengths of stay and the consequent likelihood of exceeding the aggregate cap," CMS points out in the rule.

CMS is considering changes to how it counts the unduplicated census number for the cap and requiring hospices to calculate and report their own cap. Comments on the rule are due June 22.

Resources: The 2009 cap notice is at www.cms.hhs.gov/center/hospice.asp. CMS will issue the amount officially in its 2010 rate notice this summer, it says. The proposed rule is at http://edocket.access.gpo.gov/2009/pdf/E9-9417.pdf.