Aggregate Cap on Overall Reimbursement to Medicare-certified

90.2 – Aggregate Cap on Overall Reimbursement to Medicare-certified Hospices (Rev. 246, Issued: 09-14-18, Effective: 12-17- 18, Implementation: 12-17-18) Overall aggregate Medicare payments made to a Medicare-certified hospice are subject to an aggregate cap for each cap year. The aggregate cap is calculated by multiplying a Medicare beneficiary count during the period by a statutory “cap amount.” The cap amount is adjusted annually. The Medicare beneficiary count is determined using either the proportional method or the streamlined method, as described in section 90.2.2 below. The total actual Medicare payments made for services furnished to Medicare beneficiaries during the cap year are compared to the aggregate cap for this period. “Total actual Medicare payments made for services furnished to Medicare beneficiaries during the cap year” refers to Medicare payments for services rendered during the cap year, regardless of when payment is actually made. Any actual Medicare payments in excess of the aggregate cap must be refunded by the hospice. All Medicare-certified hospices are subject to the aggregate cap calculation. When a beneficiary receives hospice care from more than one hospice, only the care provided by the Medicare-certified hospice(s) is considered when computing the aggregate cap.