Medicare Contractors Issue Final Hospice CAP Notices for 11/1/2013 to 10/31/2014 (email sent 1/7/2016)

We have had several clients who received their Final Hospice CAP Notices for the period ending 10/31/2014.  The notices include adding sequestration payments in the CAP calculations.  Yes Medicare is counting sequestration payments that you never received in your payments for the CAP calculation. 

We believe this is unfair and outside the scope of the Medicare regulations.  We have reached out to Brian Daucher a partner in the law firm of Sheppard Mullin (who led prior litigation to change the calculation of the hospice cap). Below is some information we received from Brian:

Hospice Cap – Sequestration Appeals

 As many of you know, CMS has modified it hospice cap calculation for 2013 and after by adding sequestered funds (amounts never paid) to hospice revenue.  CMS made this change without modifying the statute, regulation, or policy that calls for calculation of the cap based upon money actually paid to hospices.  Right now, many hospices are receiving “revised” 2014 cap demands that include sequestration, thus increasing the size of these demands.

These revised cap repayment demands are unfair and overstated in that they require repayment of certain funds never paid to the hospice.  Any provider facing a hospice cap demand from 2013 or later is subject to these overstated demands.  Providers have a limit of 180 days to appeal such demands.

Sheppard Mullin partner Brian Daucher (who led prior litigation to change the calculation of the hospice cap) has established fixed-fee group appeals to challenge this policy, with the goal of forcing CMS to remove sequestered amounts from the calculation.  Information related to these appeals can be found on Sheppard Mullin’s blog post atwww.hospicelaw.com within the posts for March 25, 2015 and November 3, 2015, including description of the terms of engagement and links to key documents.  You may also contact Brian directly at (714) 424-2843  Or bdaucher@sheppardmullin.com.

We will be addressing the Hospice CAP in a session titled “Hospice Update” at our upcoming “Plug in to Win” Comprehensive 2 Day Hospice Seminar in Las Vegas on January 28^th to January 29^th.