[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR418.306]



[Page 930-931]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 418_HOSPICE CARE--Table of Contents

 

                   Subpart G_Payment for Hospice Care

 

Sec. 418.306  Determination of payment rates.



    (a) Applicability. CMS establishes payment rates for each of the 

categories of hospice care described in Sec. 418.302(b). The rates are 

established using the methodology described in section 1814(i)(1)(C) of 

the Act.

    (b) Payment rates. The payment rates for routine home care and other 

services included in hospice care are as follows:

    (1) The following rates, which are 120 percent of the rates in 

effect on September 30, 1989, are effective January 1, 1990 through 

September 30, 1990 and October 21, 1990 through December 31, 1990:



Routine home care.............................................    $75.80

Continuous home care:

  Full rate for 24 hours......................................    442.40

  Hourly rate.................................................     18.43

Inpatient respite care........................................     78.40

General inpatient care........................................    337.20





    (2) Except for the period beginning October 21, 1990, through 

December 31, 1990, the payment rates for routine home care and other 

services included in hospice care for Federal fiscal years 1991, 1992, 

and 1993 and those that begin



[[Page 931]]



on or after October 1, 1997, are the payment rates in effect under this 

paragraph during the previous fiscal year increased by the market basket 

percentage increase as defined in section 1886(b)(3)(B)(iii) of the Act, 

otherwise applicable to discharges occurring in the fiscal year. The 

payment rates for the period beginning October 21, 1990, through 

December 31, 1990, are the same as those shown in paragraph (b)(1) of 

this section.

    (3) For Federal fiscal years 1994 through 1997, the payment rate is 

the payment rate in effect during the previous fiscal year increased by 

a factor equal to the market basket percentage increase minus--

    (i) 2 percentage points in FY 1994;

    (ii) 1.5 percentage points in FYs 1995 and 1996; and

    (iii) 0.5 percentage points in FY 1997.

    (c) Adjustment for wage differences. CMS will issue annually, in the 

Federal Register, a hospice wage index based on the most current 

available CMS hospital wage data, including any changes to the 

definitions of Metropolitan Statistical Areas. The payment rates 

established by CMS are adjusted by the intermediary to reflect local 

differences in wages according to the revised wage index.

    (d) Federal Register notices. CMS publishes as a notice in the 

Federal Register any proposal to change the methodology for determining 

the payment rates.



[56 FR 26919, June 12, 1991, as amended at 59 FR 26960, May 25, 1994; 62 

FR 42882, Aug. 8, 1997]