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CMS Announces the Hospice Service-Intensity Adjustment (SIA) is Here to Stay

Hospice providers are reminded that the hourly rate for Continuous Home Care (calculated to be $59.68 for FY2021) is utilized for the service-intensity adjustment (SIA) payments. This is provided to hospices for up to four hours per day in the final seven days of life for RN or social work visits provided to patients on routine home care (RHC).

In section 3 of the 42 CFR Part 418 [CMS-1733-F] Medicare Program; FY 2021 Hospice Wage Index and Payment Rate Update, effective Oct 1, 2020.


Response


After considering the comments received in response to the proposed removal of the Service Intensity Add-On Budget Neutrality Factor (SBNF), we are not finalizing the removal of the SBNF for FY 2021. As noted by commenters, we rebased the CHC payment amount in FY 2020. Given the increase to the CHC hourly rate in FY 2020, we agree that it is prudent to evaluate FY 2020 utilization data prior to eliminating the SBNF. We will continue to analyze data on visits in the last 7 days of life and whether there are changes in utilization that could affect overall budget neutrality. If there are minor SBNF adjustments in the future, suggesting that the utilization of the SIA from one year to the next remains relatively constant, we may propose to remove the factor to simplify the RHC payment rate updates in future rule-making.


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