Payment Matters: Two More Courts Invalidate CMS’s Regulations for Calculating Hospice Cap

more+
less-

Two United States district courts recently struck down CMS’s regulations for calculating hospice caps, joining nearly a dozen other federal courts that found the regulations to be contrary to the Medicare statute. Autumn Light Hospice v. Sebelius [PDF], No. CIV-09-178-M (W.D. Okla. Jan. 12, 2011), Harris Hospice, Inc. v Sebelius [PDF], Nos. 4:10cv252, 4:10cv275 (E.D. Tex. Jan. 6, 2011).

Medicare pays a hospice provider a predetermined fee for each day that an eligible patient receives hospice services. The hospice benefit includes an annual perbeneficiary cap, applied retrospectively and in the aggregate, to limit the total amount that can be paid to a hospice each year. According to the Medicare statute (42 U.S.C. § 1395f(i)(2)(c)), the cap is calculated by multiplying the number of beneficiaries who received hospice services during the accounting year (November 1 – October 31) by the per-beneficiary cap amount. The statute also provides that the number of beneficiaries for a given account year must be reduced to reflect the proportion of services a beneficiary received in an earlier or subsequent accounting year.

Please see full article below for more information.

LOADING PDF: If there are any problems, click here to download the file.


DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Ober|Kaler | Attorney Advertising

Written by:

more+
less-

Ober|Kaler on:

JD Supra Readers' Choice 2016 Awards
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:

Sign up to create your digest using LinkedIn*

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.

Already signed up? Log in here

*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.
×
Loading...
×
×