Hospice CAP Form Finally Approved

CMS has finalized the form to use in computing the self-determined hospice cap. The form labeled 'PROVIDER SELF-DETERMINED AGGREGATE CAP LIMITATION' is attached. Instructions for completing the form are also attached.  The form is only one page. The top section contains the cap computation. The lower section contains the certification statement. Be sure to complete both sections. 

Please note the following related to submitting the self-determined hospice aggregate cap for the period ended October 31, 2014.  The due date for submitting the form isMarch 31, 2015.  Only send the signed form (supporting information is not needed).  Current instructions do not include sequestration as part of hospice payments subject to the cap, if CMS moves forward to added sequestration payments to the hospice cap it will be done by the Medicare Administrative Contractor (PalmettoGBA, CGS, or NGS).

PalmettoGBA actually sent Hospice PSR's to their providers in late February.  CGS and NGS Hospice providers will be required to obtain their own PSR.  If a hospice does not currently have access to the PS&R system, please register for access through the Enterprise Identity Management System (EIDM) when that system is available. Providers will be required to register in the EIDM system in order to have access to their PS&R data and the Medicare Contractor will no longer be providing the PS&R data.

Link to Hospice CAP Form 

Link to Instructions 

Link to Palmetto GBA Hospice CAP Page 

Link to CGS Hospice CAP Page 

Link to NGS Hospice CAP Page

CMS Moving Forward with Value Based System for Home Health

CMS released a Fact Sheet titled "Health Care Payment and Learning Network".   This network if for the entire healthcare system, not just home health.  The aim is to move the health care system toward value-based-purchasing.   The goal for 2016 is to have 30% of Medicare payments into alternative payment models and increase this to 50% by 2018.  The Fact Sheet gives you the opportunity to become a participant in the overall Health Care Payment and Learning Network.  This will keep you up to date on CMS's plans for the future of the healthcare delivery system.  (This will not volunteer you to join the home health demonstration program described below)  You will have the opportunity to provide input in the overall health care system.

We learned of the Value Based Purchasing for home health agencies in the final home health prospective payment rules.  CMS pointed out it was looking for a demonstration program that would consist of all of the home health agencies in 5 to 8 states. (If your state is chosen you must participate). The proposal states the demonstration program would place 5 percent to 8 percent of home health payments at risk meaning your reimbursement could increase up or down by that amount.  We will be providing more information in future email alerts.  I will be presenting a session on Value Based Purchasing for home health agencies at the Cutting Edge Home Health Leadership Summit to be held in Maui, Hawaii on August 12th to 14th. 

Link to Fact Sheet