Two federal courts recently issued nearly identical rulings declaring the Medicare cap on hospice reimbursements to be invalid. They continue an unbroken series of rejections of the Department of Health and Human Services’ payment rule. Provider payments will be a major topic of discussion next week at the Fifth Annual McKnight’s Online Expo.
In the case of Lion Health Services Inc. v. Sebelius, the U.S. Court of Appeals for the Fifth Circuit agreed with dozens of other district courts. It ruled that the hospice reimbursement cap violates the Medicare act. The cap imposes a limit on the amount hospices can be reimbursed through Medicare per patient per year. The limit is based on the total number of patients enrolled during the year multiplied by a set amount of money per patient. Past court decisions have derided the practice as “arbitrary” and “capricious.” (McKnight’s, 3/4/10)
On Tuesday, just four days after the Fifth Circuit ruling, the U.S. Court of Appeals for the Ninth Circuit also declared the hospice cap to be unlawful. At the same time, however, that court vacated a nationwide injunction against the practice. A district court in 2009 had granted an injunction against enforcement of the regulation, but later stayed that injunction, according to the Bureau of National Affairs.
The McKnight’s webcast, “Payment: Leaving Medicare dollars on the table?” will take place at 11 a.m. Eastern/8 a.m. Pacific. Also on the docket for this year’s Online Expo are webcasts on technology, wound care, capital and quality. Attendees can earn one continuing education credit per webcast. For more information on the free event, visit www.mcknights.com/expo2011.
