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February 11, 2020

2019 Hospice Self-Determined Aggregate Cap Reminder

NOTE: If CGS does not pay your agency’s Medicare claims, we are not responsible for the Hospice Cap work for your agency. The MAC that pays your claims is whom you need to submit your SD Cap & ask questions to regarding above.

If you have not submitted the 2019 Self-Determined Cap for your agency, please complete & submit by deadline below. The Centers for Medicare & Medicaid Services (CMS) published the fiscal year (FY) 2015 Hospice Wage Index and Payment Rate Update final rule on August 22, 2014. The final rule included a requirement for hospices to file a self–determined hospice aggregate cap. Hospices are required to file the self-determined cap each year, between December 31 and February 28 (2/29 in leap years). Due to 2/29/20 falling on a Saturday the 2019 Self-Determined Caps are due no later than March 2, 2020.

As a reminder, the Hospice Caps Web page was created on the CGS website to assist hospices with this process. This Web page includes a link to the "Provider Self-Determined Aggregate Cap Limitation" form, as well as instructions for completing the form.

Hospices are responsible for obtaining their own Provider Statistical and Reimbursement (PS&R) summary from the CMS websiteExternal Website. CGS will not provide this to hospices. An instruction for obtaining your PS&R reports is also available from the Hospice Caps Web page. If a hospice is unable to obtain a copy of their PS&R reports, please contact Tom Bisbee at CGS, at 615-660-5560 for assistance.

Refer to the Hospice Caps Web page for more detailed information about this process and links to additional resources.

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