Section 3004 of the Affordable Care Act amended the Social Security Act to authorize a Medicare quality reporting program for hospices. Since 2014, Section 1814(i)(5)(A)(i) of the Social Security Act has required that the market basket update be reduced by 2 percentage points for any hospice provider not in compliance with the quality data submission requirements with respect to that FY. The Consolidated Appropriations Act of 2021 (CAA) amended Section 1814(i)(5)(A)(i) of the Act to increase the market basket reduction from 2 to 4 percentage points, beginning with FY 2024 and each subsequent FY, for any hospice provider that does not comply with the quality data submission requirements with respect to that FY. States choosing to implement this optional Medicaid hospice rate reduction for lack of quality reporting must specify its use and the penalty percentage in the Medicaid state plan. We note that the Medicaid minimum rates would be reduced by the amount of any penalty due to non-reporting.
FY 2024 Medicaid Hospice Rates for Providers that Have Not Submitted the Required Quality Data
The tables provide rates for those providers that have not complied with the reporting requirements. The tables provide the annual rates that state Medicaid agencies implementing either a 2 or 4 percentage point reduction should pay hospice providers for FY 2024. These rates can be adjusted by the hospice wage index to reflect local geographical differences in the wage levels. States retain their flexibility to pay providers more than the established minimum payments consistent with sections 1902(a)(13)(B) and 1902(a)(30)(A) of the Act. States opting to using an alternative percentage point penalty may reach out to Danielle Motley (email@example.com) or Jocelyn Kennedy (Jocelyn.firstname.lastname@example.org) for assistance with calculating the base rates for providers who have not submitted the quality data.
- 2% Point Penalty
2024 Medicaid Hospice Rates with State Elected Penalty Wage Components Subject to Index Non-Weighted Amounts Routine Home Care (days 1-60) $214.37 $141.48 $72.89 Routine Home Care (days 61 +) $169.23 $111.69 $57.54 Continuous Home Care * (full rate) $1,535.69 $1,154.84 $380.85 Continuous Home Care (hourly rate) $63.99 Impatient Respite Care $524.06 $319.68 $204.38 General Impatient Care $1,123.09 $713.16 $409.93 Service Intensity Add-On $63.99 $48.12 $15.87 Hospice Cap $33,494.01
- 4% Point Penalty
2024 Medicaid Hospice Rates with State Elected Penalty Wage Components Subject to Index Non-Weighted Amounts Routine Home Care (days 1-60) $210.13 $138.69 $71.44 Routine Home Care (days 61 +) $165.87 $109.48 $56.39 Continuous Home Care (full rate) $1,505.31 $1,131.99 $373.32 Continuous Home Care (hourly rate) $62.72 Impatient Respite Care $513.69 $313.35 $200.34 General Impatient Care $1,100.87 $699.05 $401.82 Service Intensity Add-On $62.72 $47.17 $15.55 Hospice Cap $33,494.01