[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: 42CFR418.309]



[Page 931-932]

 

                         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. 418.309  Hospice cap amount.



    The hospice cap amount is calculated using the following procedures:

    (a) The cap amount is $6,500 per year and is adjusted for inflation 

or deflation for cap years that end after October 1, 1984, by using the 

percentage change in the medical care expenditure category of the 

Consumer Price Index (CPI) for urban consumers that is published by the 

Bureau of Labor Statistics. This adjustment is made using the change in 

the CPI from March 1984 to the fifth month of the cap year. The cap year 

runs from November 1 of each year until October 31 of the following 

year.

    (b) Each hospice's cap amount is calculated by the intermediary by 

multiplying the adjusted cap amount determined in paragraph (a) of this 

section by the number of Medicare beneficiaries who elected to receive 

hospice care from that hospice during the cap



[[Page 932]]



period. For purposes of this calculation, the number of Medicare 

beneficiaries includes--

    (1) Those Medicare beneficiaries who have not previously been 

included in the calculation of any hospice cap and who have filed an 

election to receive hospice care, in accordance with Sec. 418.24, from 

the hospice during the period beginning on September 28 (35 days before 

the beginning of the cap period) and ending on September 27 (35 days 

before the end of the cap period).

    (2) In the case in which a beneficiary has elected to receive care 

from more than one hospice, each hospice includes in its number of 

Medicare beneficiaries only that fraction which represents the portion 

of a patient's total stay in all hospices that was spent in that 

hospice. (The hospice can obtain this information by contacting the 

intermediary.)