CMS Pub. 100-04, ch. 11, § 70.3

The hospice may charge the beneficiary a coinsurance amount equal to 5 percent of the

national Medicare respite care rate, after adjusting the national rate for local wage

differences. This coinsurance is not counted toward the hospital deductible, but it is

limited to the same amount.

EXAMPLE

Assume a wage adjusted inpatient respite care rate for the year (as provided by the A/B

MAC (HHH)) of $100. The maximum coinsurance rate would be $5. The hospice may

charge any amount up to and including $5 for inpatient respite care only.

The total amount of coinsurance for inpatient respite care for any beneficiary during a

hospice coinsurance period may not exceed the amount of the inpatient hospital

deductible applicable for the year in which the hospice coinsurance period began. A

hospice coinsurance period begins with the first day for which an election for hospice

services is in effect for the beneficiary and ends with the close of the first period of 14

consecutive days on which no such election is in effect for the beneficiary.

EXAMPLE

Mr. Brown elected an initial 90-day period of hospice care. Five days after the initial

period of hospice care ended, Mr. Brown began another period of hospice care under a

subsequent election. Immediately after that period ended, he began a third period of

hospice care under an additional election period. Since these election periods were not

separated by 14 consecutive days, they constitute a single hospice coinsurance period.

Therefore, the maximum coinsurance for respite care during all three periods of hospice

care may not exceed the amount of the inpatient hospital deductible for the year in which

the first period began.

No other coinsurance may be charged by the hospice.