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TRICARE Reimbursement Manual 6010.61-M, April 1, 2015
Hospice
Chapter 11
Addendum A (FY 2016)
Hospice Care Rates - FY 2016
Revision:  C-2, May 17, 2017
The FY 2016 payment rates were increased by 1.6%. The 1.6% hospice payment update is equivalent to the FY 2016 hospital market basket update (2.4%) less a productivity adjustment of 0.5%, less 0.3 percentage point.
Between October 1, 2015, and December 31, 2015, hospices will continue to be paid a single Routine Home Care (RHC) per diem payment amount. Effective January 1, 2016, two separate payment rates will be applicable for RHC. A higher RHC rate for days 1 through 60, and a lower RHC rate for days 61 and beyond of a hospice episode of care, will replace the single rate.
The following national hospice rates are for care and services provided on or after October 1, 2015, through September 30, 2016. The hospice rates applicable to the above period are:
Figure 11.A.2016-1  FY 2016 Hospice Payment Rate for RHC For October 1, 2015 Through December 31, 2015
Revenue Code
Description
FY 2016 Payment Rate
Labor Share
Non-Labor share
0651
RHC
$161.89
$111.23
$50.66
Figure 11.A.2016-2  FY 2016 Hospice Payment Rates For RHC For January 1, 2016 Through September 30, 2016
Revenue Code
Description
FY 2016 Payment Rate
Labor Share
Non-Labor share
0651
RHC (days 1 - 60)
$186.84
$128.38
$58.46
0651
RHC (days 61+)
$146.83
$100.89
$45.94
Figure 11.A.2016-3  FY 2016 Hospice Payment Rates For Continuous Home Care (CHC), Inpatient Respite Care (IRC), And General Inpatient Care For October 1, 2015 Through September 30, 2016
Revenue Code
Description
FY 2016 Payment Rate
Labor Share
Non-Labor share
0652
Continuous Home Care Full Rate = 24 hours of care = $39.37 FY 2016 hourly rate
$944.79
$649.17
$295.62
0655
Inpatient Respite Care
$167.45
$90.64
$76.81
0656
General Inpatient Care
$720.11
$460.94
$259.17
Allow the provider to split bills if they span the effective date. Use the previous year’s rates if the provider chooses not to split the bill.
Hospice Cap Amount
The latest hospice cap amount for the cap year ending October 31, 2015 is $27,820.75.
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