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Hospice Services
Overview
The Department of Community Health (DCH, Department) reimburses hospice providers who provider end of life care to eligible Medicaid members.
Medicaid hospice payment rates are calculated based on the annual hospice rates established by the Centers for Medicare and Medicaid Services (CMS).
Hospice Payment Categories
Medicaid hospice payment rates is based upon the category of hospice services received. Hospice providers provide services categorized as: Routine Home Care (RHC), Service Intensity Add-on (SIA), continuous Home Care (CHC), Inpatient Respite Care (IRC) and General Inpatient Care (GIC). Refer to Hospice Policy manual for a description and criteria for each hospice category of service.
Routine Home Care (RHC)
RHC days are reimbursed based on the day number within the hospice span of service.
Days 1-60 are paid at a higher rate and Day 61+ are paid at a lower rate. If a hospice member disenrolls from hospice for a period greater than 60 days, the hospice span starts over.
Service Intensity Add-On (SIA)
Hospice Provider receive an additional payment for services provided by a Social Woker (SW) or Registered Nurse (RN) in the last seven (7) days of a hospice members life including the date of death. The SIA payment is in addition to the RHC rate payment. The SIA payment equals the CHC hourly payment rate, for a minimum of fifteen (15) minutes up to a maximum of four (4) hours total per day for both the SW and RN. G-codes are used to identify SW, RN an LPN visits.
Hospice Rate Calculation
CMS releases the annual Hospice Rate Letter for rates effective October 1. The Georgia Medicaid Hospice rate is calculated by applying the Georgia wage-index (CMS Federal register) to the CMS hospice rate, to calculate the hospice rate specific to each county.
Effective January 1, 2016, Georgia Medicaid implemented the CMS two tier Medicare hospice reform policy for routine home care (RHC) and a Service Intensity Add-On (SIA).
Hospice Rates Effective October 1, 2023 – September 30, 2024
PDF Hospice
Rate File FFY2024
– Effective 10/01/2023
Hospice
Regions Counties FFY2024
- Posted 10/11/2023
Hospice
Cap Rate Data Request Appendix B Form
- Posted 10/25/2023
Hospice Rates Effective October 1, 2024 - September 30, 2025
The FFY2025 CSBA changes that are effective October 1, 2024 through September 30, 2025, are as follows:
- Two new Regions 35 (MARIETTA, GA) and 36 (GEORGIA) were created.
- Bartow, Cherokee, Cobb, Haralson, and Paulding County moved from Region 3 (ATLANTA-SANDY SPRINGS-ROSWELL, GA) to new Region 35 (MARIETTA, GA).
- Lamar County moved from Region 8 (GA RURAL AREA) to new Region 36 (GEORGIA).
- Lumpkin County moved from Region 8 (GA RURAL AREA) to Region 3 (ATLANTA-SANDY SORINGS-ROSWELL, GA).
Changes are reflected in the Hospice Services Policy Manual, Appendix A.
PDF
Hospice Rate File FFY 2025
Hospice
Regions Counties FFY 2025
Hospice
Cap Rate Data Request Appendix B Form
Hospice Location of Services
Hospice provider payments are based upon the county in which the hospice member lives or where the hospice services are rendered. Payments are not based upon the county in which the hospice office is located.
Hospice Services (Skilled Nursing Facilities)
The Department reimburses the hospice provider for RHC and/or CHC days of services provided to a hospice resident living in a nursing facility. The hospice payment rate is ninety-five (95%) percent of the nursing facility per diem. The Department does not pay the nursing facility directly for hospice residents.
To locate the nursing facility per diem (rate sheet), go to Nursing Home Rate Sheets.
Hospice Physician Services
The Department will reimburse the hospice provider for physician services (direct patient care) when the services are by a hospice employee or physician under agreement with the hospice provider. Refer to Medicaid Hospice manual for more information.
Hospice CAPS on Overall Reimbursement
The Department will limit overall aggregate payments made to hospice providers during the hospice cap period. The hospice cap period is November 1 – October 31 of each year. Total payments for hospice services furnished to a hospice Medicaid beneficiary during this period will be compared to the “cap amount” for this period.
Additional Resources
Licensing and Services refer to the Healthcare Facilities Regulations Division webpage for services that can be offered or other license and regulatory questions.
Provider Enrollment questions refer to GAMMIS website, Provider Enrollment.
You may contact the Department of Community Health for any additional information.
Angelica Clark Hester – Sr. Manager, [email protected]
Shandriea Crook – Supervisor, [email protected]
Kim Morris – Director of Reimbursement, [email protected]