Wis. ForwardHealth Online Handbook, Hospice, Topic #1132

Each year, the federal CMS (Centers for Medicare & Medicaid Services) establishes a maximum amount for aggregate payments

made to a hospice during a hospice cap period that runs from November 1 through October 31 of the following year. The hospice

cap period is defined as the period of time during which the payment for those hospice services counting towards the cap will be

counted, by DOS (date of service).

The aggregate payments do not include payment for direct care by the attending physician or inpatient days for persons with

AIDS. Payments made to hospices by Wisconsin Medicaid in excess of the cap on overall reimbursement will be recouped. The

Wisconsin DHS (Department of Health Services) will notify the hospice of the overpayment and the required repayment.

Payments are measured in terms of all payments made to hospices on behalf of all Medicaid hospice beneficiaries receiving

services during the cap year, regardless of which year a beneficiary is counted in when determining the cap.

The computation and application of the cap amount is made by the DMS (Division of Medicaid Services) at the end of the cap

period. The hospice will be responsible for reporting the number of Medicaid members electing hospice care during the period to

the DMS. This must be done by November 30 of each year.