Ga. Medicaid Part II Policies & Procedures for Hospice Services § 1009

The original cap amount of $6,500 per year is to increase or decrease for accounting years that end

after October 1, 1984. Index numbers will be published in the Federal Register annually and the

original cap amount of $6,500 will be adjusted each year, as appropriate.

In those situations, where a hospice begins participation in Medicaid at any time other than the

beginning of a cap year (November 1st) and hence has an initial cap calculation for a period more

than 12 months, a weighted average cap amount will be used. The following example illustrates how

this could be accomplished.

1009.1. EXAMPLE:

1009.1.1. 7/1/88 - Hospice A is Medicaid Certified.

7/1/88 to 10/31/89 - First cap period (16 months) for Hospice A.

Statutory cap for first cap year (11/1/87 - 10/31/88) = $6,500*

Statutory cap for second cap year (11/1/88 - 10/31/89) = $6,884

Weighted average cap calculation for Hospice A:

Four months (7/1/88 - 10/31/89) at $6,500 = $26,000 12 months (11/1/88

- 10/31/89) at $6,884 = $82,608 16 months period $108,608 divided by

16 = $6,788 (rounded).

In this example, $6,788 would be the weighted average cap amount to be

used in the initial cap calculation for Hospice A for the period July 1,

1988, through October 31, 1989.

NOTE:

If Hospice A had been certified in mid-month, a weighted average cap

amount based on the number of days falling within each cap period

would be used.

* Amount used for purposes of example only.