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- IN THIS CHAPTER
WE WILL BE CONTINUING CHAPTER SEVEN.
WE'VE ALREADY GONE OVER THROUGH THE FIRST PART OF THE CHAPTER
SO THIS IS A CONTINUATION
STARTING WITH THE SAFETY-NET PROVIDERS.
SAFETY-NET PROVIDERS ARE ALSO KNOWN AS
ESSENTIAL COMMUNITY PROVIDERS OR PROVIDERS OF LAST RESORT.
THE INSTITUTE OF MEDICINE HAS DEFINED
CORE SAFETY-NET PROVIDERS
AS A SET OF PROVIDERS THAT ORGANIZE AND DELIVER
A SIGNIFICANT LEVEL OF HEALTHCARE
AND OTHER HEALTH SERVICES.
THESE PROVIDERS HAVE TWO DISTINGUISHING CHARACTERISTICS.
ONE BY LEGAL MANDATE, THE ADOPTIVE MISSION THEY MAINTAIN
MUST BE AN OPEN-DOOR POLICY OFFERING SERVICE TO PATIENTS
REGARDLESS OF THEIR ABILITY TO PAY.
AND TWO, A SUBSTANTIAL SHARE OF THEIR PATIENT MIX IS UNINSURED,
MEDICAID, OR OTHER VULNERABLE PATIENTS.
SOME EXAMPLES OF SAFETY-NET PROVIDERS INCLUDE
FEDERALLY QUALIFIED HEALTH CENTERS
ALSO KNOWN AS THOSE COMMUNITY HEALTH CENTERS,
RURAL HEALTH CLINICS, MIGRANT CLINICS,
ALL THE FREE CLINICS WOULD FALL INTO THIS CATEGORY,
PUBLIC HEALTH CLINICS
AND EMERGENCY DEPARTMENTS
THAT ARE PART OF PUBLIC AND TEACHING HOSPITALS.
IN THIS POWER POINT, WE'LL REALLY BE FOCUSING
ON TWO AMBULATORY SAFETY-NET PROVIDERS FOR THIS POWER POINT.
THE FEDERALLY QUALIFIED HEALTH CENTERS OR FQHCS
AND ALSO RURAL HEALTH CLINICS OR RHCS.
FQHCS, THOSE ARE NON-PROFIT, PATIENT-GOVERNED
AND COMMUNITY-DIRECTED HEALTHCARE ENTITIES.
THEIR PURPOSE IS TO INCREASE ACCESS
TO THE BASIC HEALTH SERVICES.
THEY'RE THE LARGEST PRIMARY CARE NETWORK IN THE U.S.
WITH ABOUT 20 MILLION PATIENT'S RECEIVING CARE AT 7,900 SITES.
RHCS, THEY ARE A FEDERAL CATEGORY OF HEALTH PROVIDERS
THAT ARE UNIQUE TO RURAL AREA.
THE PURPOSE IS TO PROVIDE PRIMARY HEALTH SERVICES
IN RURAL AREAS.
THERE ARE APPROXIMATELY 3,800 RHCS IN THE UNITED STATES TODAY.
EARLY ROOTS OF COMMUNITY HEALTH CENTERS
WERE PART OF THE MIGRANT HEALTH ACT OF 1952
AND THE ECONOMIC OPPORTUNITY ACT OF 1964.
THESE ACTS PROVIDED FEDERAL SUPPORT FOR MEDICAL CARE
DELIVERED IN WHAT WERE THEN KNOWN AS MIGRANT HEALTH CENTERS
AND NEIGHBORHOOD HEALTH CENTERS.
THEN IN THE MID-1970S, NEIGHBORHOOD HEALTH CENTERS
BECAME KNOWN AS COMMUNITY HEALTH CENTERS.
AND IN THE 80S AND 90S,
CONGRESS EXPANDED THE CONCEPT OF COMMUNITY HEALTH CENTERS
TO COVER HEALTHCARE PROVIDED TO HOMELESS PEOPLE
AND RESIDENTS OF PUBLIC HOUSING
UNDER THE MCKINNEY HOMELESS ASSISTANCE ACT OF 1987.
FQHCS ARE AN EXTENSION OF THE MIGRANT
AND THE COMMUNITY HEALTH CENTER PROGRAMS.
FQHCS, THAT PROGRAM WAS ESTABLISHED
UNDER THE OBRA ACT OF 1989,
AND WAS EXPANDED
UNDER THE OMNIBUS BUDGET RECONCILIATION ACT OF 1990.
UNDER THOSE ACTS, FQHCS RECEIVED SPECIALLY ENHANCED MEDICARE
AND MEDICAID REIMBURSEMENTS.
THE HEALTH CENTERS CONSOLIDATION ACT OF 1996,
WHAT THAT DID WAS CONSOLIDATE
FOUR FEDERAL PRIMARY CARE PROGRAMS.
THAT WOULD BE COMMUNITY, MIGRANT, HOMELESS,
AND PUBLIC HOUSING.
ALL OF THOSE THEN FELL UNDER SECTION 330
OF THE PUBLIC HEALTH SERVICE ACT.
THESE FACILITIES OR PLACES CAN BE LOCATED
IN BOTH URBAN AND RURAL AREAS.
RHCS WERE ESTABLISHED
UNDER THE RURAL HEALTH CLINICAL SERVICE ACT OF 1977.
RHCS HAVE TO BE LOCATED IN A NON-URBANIZED AREA
AND AN AREA WITH HEALTH PROFESSION SHORTAGES.
RHCS INCREASE ACCESS TO PRIMARY
AND PREVENTATIVE HEALTH CARE SERVICES IN THESE RURAL AREAS.
THIS SLIDE IS A SNAPSHOT, SIDE-BY-SIDE COMPARISON
OF FQHCS AND RHCS.
YOU CAN SEE THE RHCS HAS A DEDUCTIBLE.
THEY BOTH HAVE 20% CO-INSURANCE
EXCEPT FOR PREVENTATIVE SERVICES,
COVERED VACCINES WITH NO COST-SHARING
AND HAVE SOME OTHER REQUIREMENTS
ARE LISTED IN YOUR TEXTBOOK AS WELL.
THE MAJORITY OF PATIENTS OF BOTH OF THESE
HAVE LIMITED ACCESS TO HEALTHCARE SERVICES.
SO MOST OF THE PATIENTS HAVE LOW INCOMES,
THEY'RE UNINSURED AND HAVE MEDICAID
AND ARE MEMBERS OF RACIAL OR ETHNIC MINORITIES.
THEY'RE OFTEN MEMBERS OF MEDICALLY UNDERSERVED AREAS
OR POPULATIONS.
MEDICALLY UNDERSERVED AREAS OR POPULATIONS,
THEY MAY WHOLE COUNTRIES, GROUPS OF COUNTRIES,
GROUPS OF AN URBAN AREA,
SO IT REALLY CAN BE COMBINED ANYWAY IN A DIFFERENT AREA.
MEDICALLY UNDERSERVED POPULATION,
THEY CAN BE GROUPS OF PERSONS, A CULTURE.
EXAMPLES CAN BE A GROUP OF HOMELESS PEOPLE
OR ONE GROUP OF RESIDENTS IN A CERTAIN PUBLIC HOUSING AREA.
THERE ARE SOME BENEFITS TO THE FQHC DESIGNATION,
INCLUDING THERE IS SOME START-UP GRANT FUNDING, $650,000
FEDERAL GRANT FUNDING IS UNDER SECTION 330.
MEDICAL MALPRACTICE COVERAGE IS OFFERED
THROUGH THE FEDERAL TORT CLAIMS ACT,
THE ELIGIBILITY TO PURCHASE PRESCRIPTION
AND NON-PRESCRIPTION MEDS FOR OUTPATIENTS AT A REDUCED COST.
THE ACCESS TO VACCINE FOR CHILDREN PROGRAM IS A BENEFIT
AND LASTLY ELIGIBILITY FOR VARIOUS OTHER FEDERAL GRANTS
AND PROGRAMS.
THERE ARE LOOK-ALIKE HEALTHCARE ORGANIZATIONS
THAT ARE SIMILAR TO FQHCS
IN TERMS OF ELIGIBILITY REQUIREMENTS AND BENEFITS
EXCEPT THEY DO NOT RECEIVE THAT SECTION 330 GRANT FUNDING.
ALSO QUALIFYING AS FQHCS ARE OUTPATIENT HEALTH PROGRAMS
THAT ARE OPERATED BY TRIBAL ORGANIZATION
OR URBAN INDIAN ORGANIZATIONS
AND THAT IS THE UNDER THE INDIAN SELF-DETERMINATION ACT
AND INDIAN HEALTHCARE IMPROVEMENT ACT.
GENERALLY SPEAKING, SIMILARITIES EXIST BETWEEN FQHCS AND RHCS
IN TERMS OF ELIGIBILITY AND BENEFITS.
THE KEY DIFFERENCES ARE LISTED ON THIS SLIDE FOR RHCS.
THEY MUST BE IN A NON-URBANIZED AREA AND IF YOU REMEMBER,
FQHCS CAN BE IN URBAN OR RURAL AREAS.
RHCS ARE INELIGIBLE FOR THE 340B DRUG PRICING PROGRAM.
THEY OFFER A NARROWER SCOPE OF SERVICES.
RHCS MUST HAVE MID-LEVEL PRACTITIONERS,
FOR EXAMPLE A PHYSICIAN ASSISTANT OR MIDWIFE
ON SITE AND AVAILABLE TO SEE PATIENTS
AT LEAST 50% OF THE TIME.
THEY CANNOT ALSO BE FQHCS, REHAB AGENCIES,
OR FACILITIES THAT ARE PRIMARILY DESIGNATED FOR THE TREATMENT
OF MENTAL HEALTH DISEASES.
THESE TWO SYSTEMS DO HAVE DIFFERENT PAYMENT
IN ORDER TO REFLECT A HIGHER INTENSITY
AND BROADER RANGE OF SERVICES IN OTHER SETTINGS.
THERE'S AN ALL-INCLUSIVE REIMBURSEMENT RATE
KNOWN AS AN ENCOUNTER RATE.
MEDICARE DOES REIMBURSE FHQCS AND RHCS
FOR MEDICALLY NECESSARY COVERED SERVICES
UNDER THE ALL-INCLUSIVE REIMBURSEMENT RATE,
LIKE I SAID, ALSO KNOWN AS AN ENCOUNTER RATE FOR EACH VISIT.
A VISIT IS DEFINED AS A FACE-TO-FACE ENCOUNTER
BETWEEN A PATIENT AND A PHYSICIAN,
A PHYSICIAN ASSISTANT, NURSE PRACTITIONER, MIDWIFE,
PSYCHOLOGIST, OR SOCIAL WORKER
WHEN A COVERED SERVICE IS OFFERED OR RENDERED.
THE FQHC OR RHC THEN RECEIVES THAT RATE AS REIMBURSEMENT
FOR EACH FACE-TO-FACE ENCOUNTER THAT THEY PROVIDE.
FOR EACH VISIT, THE RATE WILL BE THE SAME
REGARDLESS OF THE NUMBER OR TYPE OF COVERED SERVICES
PROVIDING THAT VISIT,
HENCE THE ALL-INCLUSIVE TERM.
THE AIRR OR IF YOU REMEMBER THAT ALL-INCLUSIVE REIMBURSEMENT RATE
OR AIRR,
THAT IS BASED ON REASONABLE COSTS
AS REPORTED ON THE COST REPORT.
FOR EACH FQHC OR RHC THE AIRR IS CALCULATED
BY DIVIDING THE TOTAL ALLOWABLE COST
BY THE NUMBER OF VISITS FOR ALL OF ITS PATIENTS.
THE AIRR IS SUBJECT TO AN ANNUAL RECONCILIATION
AND TO NATIONAL MAXIMUM PAYMENT PER VISIT CAPS OR UPPER LIMIT.
THE AIRR INCLUDES HEALTHCARE SERVICES
THAT ARE DEFINED AS COVERED FOR THESE TYPES OF ORGANIZATIONS.
EXAMPLES INCLUDE PHYSICIAN SERVICES,
SERVICES AND SUPPLIES INCIDENTAL TO WHAT PHYSICIANS USE.
THE SERVICES AGAIN, OF NURSE PRACTITIONERS, PAS, MIDWIVES,
SOCIAL WORKERS,
SERVICES AND SUPPLIES THAT THOSE INDIVIDUALS MIGHT USE.
VISITING NURSE SERVICES TO THE HOMEBOUND OR MEDICARE
DETERMINED A SHORTAGE OF HOME HEALTH AGENCIES.
MEDICARE PART B COVERED DRUGS FURNISHED BY AND INCIDENT TO
SERVICES OF THOSE PROVIDERS.
AIRR DOES NOT INCLUDE HEALTHCARE SERVICES
THAT ARE NOT DEFINED AS COVERED SERVICES.
EXAMPLES OF ITEMS COVERED UNDER MEDICARE PART B
BUT NOT UNDER THE FQHC OR RHC SERVICES
INCLUDE CERTAIN LAB TESTS, DURABLE MEDICAL EQUIPMENT,
AMBULANCE, OR THE TECHNICAL COMPONENT OF SCREENING
AND X-RAYS.
THE NATIONAL MAXIMUM PAYMENT PER VISIT DOES VARY
BY GEOGRAPHIC LOCATION AND BY ORGANIZATION TYPE.
REPRESENTATIVE PER VISIT PAYMENT LIMITS FOR 2012
ARE 79.84 FOR RHCS, 128.49 FOR URBAN FQHCS,
AND THEN FOR RURAL THAT WOULD BE $111.21.
IN TERMS OF DIFFERENCES IN CLAIM SUBMISSION,
FQHCS MUST PROVIDE MEDICARE WITH LINE-BY-LINE REPORTS
FOR ALL SERVICES RENDERED FOR EACH PATIENT VISIT.
EACH LINE MUST CONTAIN APPROPRIATE HCPCS OR CPT CODES
AND REVENUE CODES.
ON THE OTHER HAND, RHCS ONLY NEED TO SUBMIT HCPCS
OR CPT CODES
FOR SPECIFIED PREVENTATIVE SERVICES
AS DEFINED BY THE U.S. PREVENTATIVE SERVICES
TASK FORCE.
CLAIMS SUBMISSION FOR BOTH DOES DIFFER
ON THE RANGE OF REVENUE CODES AND ON THE USE OF MODIFIER 59,
WHICH IS NOT REQUIRED FOR RHCS.
STATES' MEDICARE PROGRAM DO REIMBURSE BOTH OF THESE
USING A PERSPECTIVE PAYMENT SYSTEM METHODOLOGY
BASED ON HISTORICAL REASONABLE COSTS OF THIS CENTER
OR THE CLINIC.
THIS PPS METHODOLOGY DOES VARY BY STATE
AND THE PAYMENT RATE MAY BE CLINIC SPECIFIC.
NOW WE WILL MOVE ON TO THE HOSPICE SERVICE PAYMENT SYSTEM,
THE LAST PART OF CHAPTER SEVEN.
A HOSPICE USES AN INTERDISCIPLINARY APPROACH
TO DELIVER MEDICAL, SOCIAL, NURSING, PSYCHOLOGICAL,
EMOTIONAL, AND SPIRITUAL SERVICES
THROUGH A BROAD SPECTRUM OF HEALTHCARE PROFESSIONALS
AND CAREGIVERS.
THESE ARE FOR SERVICES PROVIDED TO TERMINALLY ILL PATIENTS
AND THEIR FAMILIES.
THE IMPORTANT PIECE THERE IS IT'S NOT JUST FOR THE PATIENT
BUT IT'S ALSO FOR THE FAMILY MEMBERS
DEALING WITH THE LOSS OF A LOVED ONE.
PALLIATIVE SERVICES ARE DESIGNED TO RELIEVE PAIN AND SUFFERING.
WE'RE NOT GOING TO BE TREATING OR CURING DISEASES
JUST TRYING TO KEEP THE PATIENT COMFORTABLE.
PATIENTS WHEN THEY GET TO HOSPICE
THEY HAVE MADE THE DECISION
THAT THEY ARE NOT GOING TO TRY AND SEEK A CURE.
THEY ARE JUST LIVING OUT THEIR REMAINING DAYS
HOPEFULLY PAIN FREE
AND HELPING THEMSELVES AND THEIR FAMILY MEMBERS
GO THROUGH THE GRIEVING PROCESS.
COVERED SERVICES INCLUDE ALL OF THE ITEMS ON THIS SLIDE
AND RESPITE CARE THERE TOWARD THE END,
THAT'S RELIEF FOR CAREGIVERS
AND THAT CAN BE UP TO FIVE DAYS PER INPATIENT HOSPITALIZATION
TO GIVE THE FAMILY MEMBERS THAT ARE CARING FOR THE PATIENT
A BREAK.
THE GOAL OF HOSPICE IS TO MAKE PATIENTS
PHYSICALLY AND EMOTIONALLY AS COMFORTABLE AS POSSIBLE.
THEIR GOAL IS NOT TO CURE THE PATIENT
BUT TO KEEP THEM COMFORTABLE.
THE BROAD SPECTRUM OF PROFESSIONAL
AND OTHER CAREGIVERS
CAN INCLUDE ALL OF THOSE LISTED ON THIS SLIDE.
TYPICALLY, HOSPICE SERVICES ARE DELIVERED IN A PATIENT'S HOME,
HOWEVER HOSPICE CAN BE PROVIDED IN AN INPATIENT SETTING
OR MANY OTHER SETTINGS AS WELL.
HOSPICE USE IS INCREASING DRAMATICALLY
WITH MORE THAN 3,500 MEDICARE PARTICIPATING HOSPICES
AND MORE THAN HALF OF THOSE ARE FOR PROFIT AT THIS TIME.
HOSPICE IS COVERED UNDER MEDICARE PART A.
THE HOSPICE BENEFIT BEGAN IN 1983, AS AUTHORIZED BY TEFRA.
COVERAGE INCLUDES THE FOLLOWING:
TWO PHYSICIANS MUST CERTIFY THE PATIENT IS TERMINALLY ILL
AND HAS SIX MONTHS OR LESS TO LIVE.
THE BENEFICIARY HAS ELECTED IN THIS MEDICARE HOSPICE
IN WRITING,
THEREFORE AGREEING TO FOREGO ANY CURATIVE TREATMENT,
A WRITTEN PLAN OF CARE HAS BEEN ESTABLISHED
AND IS MAINTAINED BY THE PHYSICIAN
OR SOME OTHER HOSPICE PHYSICIAN THAT'S PART OF THAT GROUP.
THE PLAN IDENTIFIES SERVICES TO BE PROVIDED
SUCH AS PAIN RELIEF
AND THE SCOPE AND FREQUENCY OF SERVICES NEEDED TO BE MET
TO MEET THE NEEDS OF THAT PATIENT
AND OF THEIR FAMILY MEMBERS.
BENEFICIARIES MAY ELECT DEFINED BENEFIT PERIODS.
THE FIRST HOSPICE BENEFIT PERIOD IS 90 DAYS.
AS STATED PREVIOUSLY, TWO PHYSICIANS MUST CERTIFY
THE PATIENT IS LIKELY TO DIE WITHIN SIX MONTHS.
THAT DOES NOT ALWAYS HAPPEN.
ONLY THE HOSPICE PHYSICIAN MAY RECERTIFY THE PATIENT
FOR ANOTHER 90 DAYS
IF THE PATIENT'S DEATH IS STILL LIKELY
WITHIN THE NEXT SIX-MONTH TIMEFRAME.
BEFORE THE PATIENT'S 180-DAY RECERTIFICATION
OR THE THIRD BENEFIT PERIOD,
A HOSPICE PHYSICIAN OR NURSE PRACTITIONER
MUST HAVE A FACE-TO-FACE ENCOUNTER WITH THAT PATIENT.
THE ENCOUNTER MUST OCCUR NO MORE THAN 30 DAYS
PRIOR TO THE START OF HOSPICE OF THAT THIRD BENEFIT PERIOD.
AFTER THE 180-DAY RECERTIFICATION,
THE PATIENT CAN BE RECERTIFIED
FOR AN UNLIMITED NUMBER OF 60-DAY PERIODS.
EACH SUBSEQUENT RECERTIFICATION ALSO REQUIRES
A FACE-TO-FACE ENCOUNTER.
THE PATIENT'S COST-SHARING FOR HOSPICE IS VERY MINIMAL.
THERE'S NO DEDUCTIBLE.
FOR ANY PRESCRIPTION, HOSPICE MAY CHARGE 5% CO-INSURANCE
BUT THAT SHOULD NOT EXCEED $5.00 FOR EACH PRESCRIPTION
THAT'S FURNISHED OUTSIDE OF THE INPATIENT SETTING.
FOR INPATIENT RESPITE CARE, BENEFICIARIES MAY BE CHARGED
5% OF MEDICARE'S RESPITE CARE PAYMENT PER DAY COST.
THE UNIT OF PAYMENT IS THE ENROLLED DAY.
MEDICARE PAYS A DAILY RATE TO HOSPICE FOR EACH DAY
A BENEFICIARY IS ENROLLED IN HOSPICE.
THE DAILY RATE IS ALL-INCLUSIVE.
ALL COST AND SERVICES RELATED TO THE PATIENT'S TERMINAL ILLNESS
ARE INCLUDED IN THAT DAILY RATE.
THE DAILY RATE IS NOT RELATED TO THE AMOUNT OF SERVICES
THE HOSPICE PROVIDES.
THE RATE FOR THE DAY WITH NO VISIT AND NO SERVICES
IS THE SAME AS THE RATE FOR A DAY WITH A VISIT
AND MANY SERVICES.
SERVICES AND ITEMS THAT ARE UNRELATED
TO THE PATIENT'S TERMINAL ILLNESS,
SUCH AS AN ACCIDENT OR A FALL,
THEY'RE NOT INCLUDED IN THE DAILY RATE
AND ARE THEN COVERED UNDER MEDICARE PART A AND PART B
AS APPLICABLE WITH APPROPRIATE DEDUCTIBLES AND CO-INSURANCE.
CARE OF HOSPICE PATIENT'S IS DIVIDED INTO FOUR CATEGORIES
BASED ON LOCATION AND INTENSITY OF SERVICE.
EACH OF THE FOUR CATEGORIES OF CARE
HAS A DAILY BASE PAYMENT RATE.
YOU CAN SEE THE FOUR TYPES LISTED DOWN HERE
AS WELL AS THEIR PAYMENT RATE.
THE STEPS TO CALCULATING A PAYMENT, STEP ONE,
EACH DAY OF HOSPICE CARE
IS ASSIGNED TO ONE OF FOUR CATEGORIES.
THE HOSPICE PROVIDER IS PAID
ON A DAILY BASE PAYMENT FOR THAT DAY.
THEREFORE, ON VARIOUS DAYS,
DIFFERENT DAILY BASE PAYMENT RATES MAY BE PAID
FOR ONE PATIENT.
FOR STEP TWO, WE ADJUST THE CATEGORIES' BASE PAYMENT RATE
FOR GEOGRAPHIC FACTORS AND INTENSITY OF HUMAN RESOURCES.
THE HOSPICE DAILY PAYMENT RATES ARE ADJUSTED GEOGRAPHICALLY
TO ACCOUNT FOR DIFFERENCES IN WAGE RATES AMONG LOCAL MARKET,
IN ADDITION TO ACCOUNT FOR DIFFERENCES IN LABOR COSTS
IN THE DIFFERENT CATEGORIES.
EACH CATEGORY OF CARE HAS A BASE RATE
AND A LABOR SHARE AND A NON-LABOR SHARE.
THE LABOR SHARE IS ADJUSTED BY THE HOSPICE WAGE INDEX
BASED ON WHERE THE CARE WAS FURNISHED.
STEP THREE, PAYMENT IS CALCULATED
AS THE NUMBER OF DAYS IN EACH CATEGORY
MULTIPLIED BY THE CATEGORY BASE DAILY PAYMENT AMOUNT
AND ADJUSTED FOR GEOGRAPHIC FACTORS AND LABOR INTENSITY.
TWO LIMITS OR CAPS ON HOSPICE SERVICES DO EXIST.
THE NUMBER OF DAYS OF INPATIENT CARE
THAT A HOSPICE PROVIDER CAN RENDER
CANNOT EXCEED 20% OF TOTAL PATIENT DAYS.
THE HOSPICE AGGREGATE CAP AMOUNT IS THE SECOND.
MEDICARE AGGREGATES ALL THE PAYMENTS TO HOSPICE PROVIDERS.
THE TOTAL PAYMENTS CANNOT EXCEED THE CAP.
THE AGGREGATE CAP AMOUNT IS A DOLLAR LIMIT
BASED ON AVERAGE ANNUAL PAYMENT PER BENEFICIARY.
HOSPICE SERVICES, LIKE WE TALKED ABOUT,
PROVIDE CARE TO INDIVIDUALS IN THEIR LAST SIX MONTHS OF LIFE.
REIMBURSEMENT TO HOSPICE IS BASED
ON AN ALL-INCLUSIVE DAILY PAYMENT RATE.
THERE ARE FOUR CATEGORIES OF PAYMENT RATES.
THESE PAYMENT AMOUNTS CAN BE ADJUSTED FOR GEOGRAPHIC FACTORS
AND INTENSITY OF LABOR
AND THERE IS CAPS ON PAYMENTS TO HOSPICE PROVIDERS.