CMS Geographic Designations Could Slash Payment for Some Hospice Providers

POSTED ON MONDAY, August 10, 2020 

A final rule governing hospice payment from CMS has adopted a new method for defining different regions as rural or urban. This change will impact geographic adjustments to per diem amounts resulting in payment reductions for some providers.

“Effective at the start of the Fiscal Year in October, CMS will be using the White House Office of Management and Budget’s (OMB) statistical area delineations that were made public in September 2018. These delineations determine whether a county is considered rural or urban, and so forth. This applies a 5% cap on any decrease to the wage index used to calculate hospice payments.

“Some individual counties are seeing their core-based statistical area (CBSA) changing. Some of those are changing from rural to urban, others are urban to rural, and others are just a different configuration of counties for a rate,” Judi Lund Person, vice president for regulatory and compliance for the National Hospice & Palliative Care Organization, told Hospice News. “Certainly, we’re seeing some counties that have a decrease in their wage index values, the decrease is a maximum of 5% for FY 2021. That’s kind of a heads up from CMS to get ready. If you’re one of those counties with a decrease in the wage index that will definitely, very significantly, impact your rate.”

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