CMS Pub. 100-02, ch. 9, § 90.2.3

Hospices are not allowed to switch back and forth between cap calculation methods, as

doing so would greatly complicate the cap determination calculation, would be difficult

to administer, and could lead to inappropriate switching by hospices seeking merely to

maximize Medicare payments. Additionally, in the year of a change in the calculation

method or when a previous cap determination cannot be re-opened, there is a potential for

over-counting some beneficiaries. Allowing hospices to switch back and forth between

methods would perpetuate the risk of over-counting beneficiaries. Therefore:

1) Hospices that have their cap determination calculated using the proportional

method for any cap year prior to the 2012 cap year will continue to have their cap

calculated using the proportional method for the 2012 cap year and all subsequent cap

years; and,

2) All other hospices would have their cap determinations for the 2012 cap year and

all subsequent cap years calculated using the proportional method unless they make a

one-time election to have their cap determinations for cap year 2012 and beyond

calculated using the streamlined method. A/B MACs (HHH) do not reopen cap

determinations for the 2011 cap year and prior cap years as a result of a hospice transition

from the streamlined to the proportional method for the 2012 cap year. NOTE: this does

not apply to hospices that appealed their cap determination.

3) A hospice would be able to elect the streamlined method no later than 60 days

following the receipt of its 2012 cap determination.

4) Hospices which elected to have their cap determination calculated using the

streamlined method may later elect to have their cap determinations calculated using the

proportional method by either:

a. electing to change to the proportional method (if the election is made prior to

receipt of the cap determination associated with the cap year where the change

is desired); or

b. appealing a cap determination calculated using the streamlined method to

determine the number of Medicare beneficiaries.

5) If a hospice elected the streamlined method, and changed to the proportional

method for a subsequent cap year, the hospice’s aggregate cap determination for that cap

year (i.e., the cap year of the change) and all subsequent cap years would be calculated

using the proportional method. Past cap year determinations for the 2012 cap year and

later cap years are subject to reopening; existing re-opening rules allow reopening for up

to 3 years from the date of the cap determination, except in cases of fraud, where

reopening is unlimited. A revised cap determination letter issued as a result of reopening

may itself be reopened, subject to the 3 year limitation on reopening.