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Presenter explains CMS hospice payments and the service intensity add‑on
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Summary
An educational CMS video outlines the four hospice payment levels — routine home care, continuous home care, inpatient respite and general inpatient care — and explains the service intensity add‑on (SIA): when it applies, how units are counted, and how payments are calculated with an example.
A presenter for a Centers for Medicare & Medicaid Services (CMS) educational video explained how CMS pays hospice agencies and how the service intensity add‑on (SIA) works.
The presenter said, “The Centers for Medicare and Medicaid Services, referred to as CMS, provides payment for hospice care to patients who meet certain criteria.” The video summarizes the four payment levels: routine home care, continuous home care, inpatient respite care and general inpatient care, and notes CMS pays a daily rate for each day a patient is enrolled in the hospice benefit, with rates varying by level of care.
Routine Home Care (RHC) covers patients receiving hospice care at home, in a skilled nursing facility, or in an assisted living facility and excludes continuous home care. Continuous Home Care (CHC) is described as nursing‑focused care provided during a period of crisis to manage acute medical symptoms; the presenter said CHC provides a minimum of eight hours of care and that more than half of qualifying hours must be provided by an RN and an LPN or LVN, with aides allowed to supplement nursing care.
Inpatient respite care was described as hospice care in an approved inpatient facility for up to five consecutive days when necessary to relieve family members or other caregivers. General inpatient care covers hospice services in an inpatient facility for acute or chronic symptom management or pain control that cannot be managed in other settings.
The presenter introduced the service intensity add‑on (SIA) as an additional payment available for certain in‑person registered nurse and social worker visits provided during the last seven days of life. The video states the SIA applies only to routine home care reimbursements and not to continuous home care, inpatient respite care, or general inpatient care. The presenter emphasized that services paid under SIA must be provided in person and that phone calls are not eligible.
SIA is calculated in 15‑minute units. The presenter said the minimum service time covered per day is 15 minutes and the maximum combined nursing and social worker time per day is four hours (16 units). The SIA payment amount is computed by multiplying the number of hours (converted from 15‑minute units) by the current wage‑adjusted rate for continuous home care; the Medicare claims processing system will calculate the SIA for qualifying visits in the last seven days of life, so hospices do not need to submit a separate SIA claim.
As a demonstration, the presenter used an example in which a registered nurse bills three units (45 minutes, or 0.75 hours). Using an illustrative wage‑adjusted rate of $69.76 for continuous home care, 0.75 hours multiplied by that rate yields a sample SIA payment of $52.32; the presenter noted this example is for demonstration only and wage‑adjusted rates vary year to year.
For more information, the presenter directed viewers to CMS webpages on hospice payment and provider enrollment and provided an email contact (hospicepolicy@hhs.gov). The video closed with a disclaimer that the content is a summary, not legal guidance; official Medicare program legal guidance, the presenter said, is found in the relevant statutes, regulations and CMS materials.
