Mich. Medicaid Provider Manual, Hospice § 7.3.A

MDHHS uses the Medicaid hospice payment base rates established and provided by CMS

and applies the appropriate local wage adjustors provided by CMS for the four categories

of hospice care in each Core Based Statistical Area (CBSA). Effective for dates of service

on or after January 1, 2016, a severity intensity add-on (SIA) rate will be reimbursed for

a minimum of 15 minutes but not more than four hours daily during the last seven days

of a beneficiary’s life for in-person visits made by an RN and/or Social Worker when the

beneficiary is receiving routine home care. (This payment is made in addition to the

routine home care rate for the day.) However, the total of combined time rendered by

an RN and Social Worker will not be reimbursed for more than four hours a day.

Medicaid Fee for Service hospice providers who have not submitted required quality data

to the Centers for Medicare & Medicaid Services (CMS) in compliance with the Hospice

Quality Reporting Program (HQRP) will receive reduced reimbursement. Medicaid

publishes and implements rate updates each fiscal year or when directed by CMS. (Refer

to the MDHHS Hospice Reimbursement Rates on the MDHHS website.)