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. - END -