The Centers for Medicare & Medicaid Services yesterday released a proposed rule for Medicare hospice providers that would provide a net payment update of 1.3%, or $200 million, in fiscal year 2016. The increase includes a 2.7% market basket update, which is reduced by Affordable Care Act-mandated adjustments of 0.6% and 0.3%; a 0.7% decrease to account for updated wage data and the final installment of the budget neutrality adjustment factor phase-out; and a 0.2% increase for new area wage index boundaries. In addition, CMS proposes a new two-tiered system for per diem rates for “routine hospice care,” the most common among the four levels of care, intended to more accurately align hospice payments with intensity of services. Specifically, CMS proposes a higher rate of $188.20 for the first two months of care, since costs are greater in the earlier portion of a hospice episode, and a lower rate of $147.34 for days 61 and later. The rule also proposes an add-on payment for certain “routine hospice care” provided during the last seven days of life to address the more resource-intensive services associated with that week. For hospice patients who are discharged and readmitted to hospice within 60 days, the initial hospice days will be counted when determining which per diem rate should apply for routine hospice care. CMS would implement both the dual-rate structure and the new payment add-on in a budget-neutral manner. CMS will accept comments on the proposed rule through June 29.