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CMS Releases Capitation Rates for Hospice Coverage Through Medicare Advantage

Posted on Monday, March 2, 2020 1:52 PM

CMS has announced the capitation rates for hospice care under the value-based insurance design model (VBID), also known as the Medicare Advantage hospice carve-in. 

The hospice capitation rate is designed to reflect all FFS costs – both hospice and non-hospice FFS payments – that CMS paid while a beneficiary elected the hospice benefit (including various levels of care). For the first month of hospice care, the hospice monthly capitation rate will be adjusted depending on the length of time that a patient is on hospice care. CMS will adjust the first month hospice payment based on whether the patient is on service for 1 to 6 days, receives 7 to 15 days of care in the first month, and a different rate for those patients who receive 16 or more days of hospice care during the initial month. For month 2 and subsequent months, the MA plan will be paid the full hospice capitation rate.  For the first 6 days the rate is $1,764, for days 7 thru 15 the base rate is $3,320 and days 16+ the base rate is $5,291.

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