TEXAS HEALTH AND HUMAN SERVICES COMMISSION RATE ANALYSIS ...

TEXAS HEALTH AND HUMAN SERVICES COMMISSION RATE ANALYSIS DEPARTMENT October 2, 2019 Proposed Payment Rates For Medicaid Hospice

Payment rates are proposed to be effective October 1, 2019

SUMMARY OF PROPOSED PAYMENT RATES Effective October 1, 2019

The Health and Human Services Commission (HHSC) will conduct a public hearing at 9:00 a.m. on October 2, 2019, in the Public Hearing Room of the Brown-Heatly Building located at 4900 N. Lamar Boulevard, Austin, Texas. Public comments will be received on proposed Medicaid Community Hospice payment rates to be effective on October 1, 2019.

HHSC will consider concerns expressed at the hearing prior to final rate approval. This public hearing is held in compliance with the provisions Human Resources Code ?32.0282, and the Texas Administrative Code (TAC) Title 1, ?355.105(g), which require a public hearing on proposed payment rates.

PROPOSED RATES HHSC is proposing to increase payment rates for Medicaid Community Hospice for routine home, continuous home, inpatient respite, and general inpatient care services to be effective October 1, 2019. The proposed rates are outlined in the attachments to this packet. One payment rate schedule applies to hospice providers that have submitted required quality data and the other payment rate schedule applies to hospice providers that have not submitted the required quality data.

METHODOLOGY AND JUSTIFICATION HHSC rate methodologies for the proposed Medicaid Community Hospice reimbursement rates were determined in accordance with federal regulations on payment for hospice care, located at the Code of Federal Regulations, Title 42, Part 418, Subpart G.

Regulation number CMS-1714-F from the Centers for Medicaid and Medicaid Services (CMS), published August 6, 2019, contains the Medicaid hospice payment rates for federal fiscal year 2020 that HHSC is proposing. The final rule may be accessed at the following link:

Please contact the Rate Analysis Department's Customer Information Center at (512) 424-6637 or by email at RAD-LTSS@hhsc.state.tx.us should you have any questions regarding the information in this document.

Proposed Hospice Payment Rates: Federal Fiscal Year 2020

Effective October 1, 2019

Proposed Hospice Rates for Providers that Have Submitted the Required Quality Data

Wage

Component

Non-

Subject to

Weighted

Service Description

Daily Rate

Index

Amount

Routine home care (days 1-60)

$194.75

$133.81

$60.94

Routine home care (days 61+)

$153.92

$105.76

$48.16

Service Intensity Add-On

$58.17

$39.97

$18.20

Continuous home care for 24 hours of care ($58.17 hourly rate)

$1,396.17

$959.31

$436.86

Inpatient respite care

$473.79

$256.46

$217.33

General inpatient care

$1,021.25

$653.70

$367.55

County-level Hospice Rates for Providers that Have Submitted the Required Quality Data Effective October 1, 2019

County Name Anderson Andrews Angelina Aransas Archer Armstrong Atascosa Austin Bailey Bandera Bastrop Baylor Bee Bell Bexar Blanco Borden Bosque Bowie Brazoria Brazos Brewster Briscoe Brooks Brown

County Number

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

CBSA 99945 99945 99945 18580 48540 11100 40980 26420 99945 40980 12420 99945 99945 28660 40980 99945 99945 99945 45500 26420 17780 99945 99945 99945 99945

FFY20 Hospice

Wage Index 0.8131 0.8131 0.8131 0.9362 0.7505 0.8411 0.8629 1.0018 0.8131 0.8629 0.9396 0.8131 0.8131 0.9618 0.8629 0.8131 0.8131 0.8131 0.8540 1.0018 0.8764 0.8131 0.8131 0.8131 0.8131

Continuous Home Care

$1,216.87 $1,216.87 $1,216.87 $1,334.97 $1,156.82 $1,243.74 $1,264.65 $1,397.90 $1,216.87 $1,264.65 $1,338.23 $1,216.87 $1,216.87 $1,359.52 $1,264.65 $1,216.87 $1,216.87 $1,216.87 $1,256.11 $1,397.90 $1,277.60 $1,216.87 $1,216.87 $1,216.87 $1,216.87

Inpatient Respite Care $425.86 $425.86 $425.86 $457.43 $409.80 $433.04 $438.63 $474.25 $425.86 $438.63 $458.30 $425.86 $425.86 $463.99 $438.63 $425.86 $425.86 $425.86 $436.35 $474.25 $442.09 $425.86 $425.86 $425.86 $425.86

General Inpatient

Care $899.07 $899.07 $899.07 $979.54 $858.15 $917.38 $931.63 $1,022.43 $899.07 $931.63 $981.77 $899.07 $899.07 $996.28 $931.63 $899.07 $899.07 $899.07 $925.81 $1,022.43 $940.45 $899.07 $899.07 $899.07 $899.07

Routine Home Care (days 1-60)

$169.74 $169.74 $169.74 $186.21 $161.36 $173.49 $176.40 $194.99 $169.74 $176.40 $186.67 $169.74 $169.74 $189.64 $176.40 $169.74 $169.74 $169.74 $175.21 $194.99 $178.21 $169.74 $169.74 $169.74 $169.74

Routine Home Care (days 61+) $134.15 $134.15 $134.15 $147.17 $127.53 $137.11 $139.42 $154.11 $134.15 $139.42 $147.53 $134.15 $134.15 $149.88 $139.42 $134.15 $134.15 $134.15 $138.48 $154.11 $140.85 $134.15 $134.15 $134.15 $134.15

Service Intensity Add-On

$50.70 $50.70 $50.70 $55.62 $48.20 $51.82 $52.69 $58.24 $50.70 $52.69 $55.76 $50.70 $50.70 $56.64 $52.69 $50.70 $50.70 $50.70 $52.33 $58.24 $53.23 $50.70 $50.70 $50.70 $50.70

Burleson Burnet Caldwell Calhoun Callahan Cameron Camp Carson Cass Castro Chambers Cherokee Childress Clay Cochran Coke Coleman Collin Collingsworth Colorado Comal Comanche Concho Cooke Coryell Cottle Crane Crockett Crosby Culberson Dallam Dallas

26

17780 0.8764 $1,277.60 $442.09 $940.45

$178.21

$140.85 $53.23

27

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

28

12420 0.9396 $1,338.23 $458.30 $981.77

$186.67

$147.53 $55.76

29

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

30

10180 0.8520 $1,254.19 $435.83 $924.50

$174.95

$138.27 $52.25

31

15180 0.8547 $1,256.78 $436.53 $926.27

$175.31

$138.55 $52.36

32

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

33

11100 0.8411 $1,243.74 $433.04 $917.38

$173.49

$137.11 $51.82

34

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

35

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

36

26420 1.0018 $1,397.90

$474.25 $1,022.43

$194.99

$154.11 $58.24

37

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

38

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

39

99945 0.7505 $1,156.82 $409.80 $858.15

$161.36

$127.53 $48.20

40

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

41

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

42

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

43

19124 0.9747 $1,371.90

$467.30 $1,004.71

$191.36

$151.24 $57.16

44

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

45

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

46

40980 0.8629 $1,264.65 $438.63 $931.63

$176.40

$139.42 $52.69

47

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

48

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

49

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

50

28660 0.9618 $1,359.52 $463.99 $996.28

$189.64

$149.88 $56.64

51

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

52

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

53

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

54

31180 0.8420 $1,244.60 $433.27 $917.97

$173.61

$137.21 $51.85

55

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

56

99945 0.8131 $1,216.87 $425.86 $899.07

$169.74

$134.15 $50.70

57

19124 0.9747 $1,371.90

$467.30 $1,004.71

$191.36

$151.24 $57.16

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