Service Intensity Add-on (SIA) Payments

30.2.2 – Service Intensity Add-on (SIA) Payments (Rev. 3502, Issued: 04-28-16, Effective: 01- 01-16, Implementation: 10-03-16) Effective for hospice services with dates of service on and after January 1, 2016, a service intensity add-on payment will be made for the social worker visits and nursing visits provided by a registered nurse (RN), when provided during routine home care in the last seven days of life. The SIA payment is in addition to the routine home care rate. The SIA payment is provided for visits of a minimum of 15 minutes and a maximum of 4 hours per day, i.e. from 1 unit to a maximum of 16 units combined for both nursing visit time and/or social worker visit time per day. In addition, the time of a social worker’s phone calls is not eligible for an SIA payment. The SIA payment amount is calculated by multiplying the continuous home care (CHC) rate (per 15 minutes) by the number of units for the combined visits for the day (payment not to exceed 16 units) and adjusted for geographic differences in wages. EXAMPLE CLAIM: End of Life (EOL) 7 day SIA: Billing Period: 12/01/XX – 12/09/XX, Patient Status: 40 RHC in home, discharged deceased. Revenue Code HCPCS Line Item Date of Service Units 0651 Q5001 12/01/XX 9 0551 G0299 12/01/XX 4 0571 G0156 12/02/XX 6 0561 G0155 12/05/XX 4 0571 G0156 12/05/XX 3 0551 G0299 12/06/XX 3 0571 G0156 12/06XX 4 0551 G0299 12/09/XX 4 0561 G0155 12/09/XX 6 0571 G0156 12/09/XX 2 *Visits reported prior to 12/03/XX are not included in the EOL 7 day SIA. Day 1 of 7, 12/03/XX, no qualifying units reported for the EOL SIA. Day 2 of 7, 12/04/XX, no qualifying units reported for the EOL SIA. Day 3 of 7, 12/05/XX, qualifying units are 4. Day 3 of the EOL SIA payment is stored on the first applicable visit line for that date: 0561 G0155 12/05/XX UNITS 4. Day 4 of 7, 12/06/XX, qualifying units are 3. Day 4 of the EOL SIA payment is stored on the first applicable visit line for that date: 0551 G0299 12/06/XX UNITS 3. Day 5 of 7, 12/07/XX, no qualifying units reported for the EOL SIA. Day 6 of 7, 12/08/XX, no qualifying units reported for the EOL SIA. Day 7 of 7, 12/09/XX, qualifying units are 10. Day 7 of the EOL SIA payment is stored on the first applicable visit line for that date: 0551 G0299 12/09/XX UNITS 4.