Medicare Hospice Benefit Reimbursement Rates
Under the Medicare Hospice Benefit, Medicare pays for hospice care on the basis of a set rate for each day of the patient's election of hospice care. There are four different levels of payment that may be made, depending on the type of care provided on a given day.
The actual amount of money paid Perdiem is set on a regional basis and is adjusted for the costs of providing care in that area. The cost variations generally relate to the cost of labor.
- Routine home care rate. This rate covers care provided to patients who are at home (defined as the patient's own home or wherever the patient considers home, such as a nursing home). It runs about $107 per day for the care of the patient in his/her own home.
- Continuous home care rate. This rate covers care at home during a period of crisis and consists primarily of nursing care on a continuous basis. It runs about $624 per day. Care may be reimbursed at thequivalent hourly rate for less than 24 hours.
- General inpatient care rate. This rate pays for inpatient care when necessary for pain control or acute or chronic symptom management that cannot feasibly be provided in other settings. It runs about $476 per day. Hospice programs are responsible for providing general inpatient care directly or for making arrangements with an appropriate provider (a hospital, a nursing home, or another hospice provider with inpatient capability).
- Inpatient respite care rate. This care must be providedby the certified hospice program in a napproved inpatient facility when necessary to provide a respite to family members or others caring for the hospice patient. The respite rate is approximately $111/day..
At least 80% of the aggregate days of care provided by a hospice program must be at home.
Physician services related to oversight of the plan of care by the hospice program's medical director are covered in the daily rates paid to the hospice program.
Physician services for clinical care to the patient and family are not covered under the
Benefit. These services can be billed directly to Medicare (see
financing physicians).
Further details of the Medicare Hospice Benefit can be found in the
Health Care Financing Administration's Hospice Manual (HCFA, last updated Oct. 2001)
A consumer's guide to the Medicare Hospice Benefit (PDF)
(
Spanish Version PDF)
As with all entitlements, there have been unintended consequences of the Benefit.
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CAPCManual Attribution:
von Gunten CF,
Ferris FD,
Portenoy RK,
Glajchen M, eds.
CAPCManual: How to Establish A Palliative Care Program.
New York, NY: Center to Advance Palliative Care, 2001.
©
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, CA
and
The Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, 2001
Permission to reproduce for non-commercial educational purposes with display of
attribution and
copyright is granted.
Last updated: February 20, 2002
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