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January 19, 2023

2022 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. Submit your SD Cap and direct any questions to the MAC that pays your claims.

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. The 2021 Self-Determined Caps are due no later than February 28, 2023. If we do not receive the self-determined cap within 7 days of the above due date, we will issue a Past Due letter and suspend payments.

As a reminder, the Hospice Caps Web page includes a "Provider Self-Determined Aggregate Cap Limitation" form and instructions to assist with this process.

Hospices must obtain their own Provider Statistical and Reimbursement (PS&R) summary from the CMS websiteExternal website. These instructions are also available on the Hospice Caps Web page. CGS will only provide PS&R reports if a hospice is unable to obtain a copy. Please contact Tom Bisbee at 615.660.5560 for assistance.

Refer to the Hospice Caps Web page for detailed information and additional resources.

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