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Audit of Medicaid's Hospice Inpatient and Aggregate Cap Calculations

Under Medicare, CMS requires two annual limits to ensure that hospice care does not exceed the cost of conventional medical care at the end of life: the inpatient cap and the aggregate cap. Under Medicaid, however, CMS only requires States to calculate the hospice inpatient cap, and calculating the aggregate cap is optional for each State. If a State applies the hospice caps, any amount paid to a hospice for its claims in excess of each cap is considered an overpayment and must be repaid to Medicaid. We will audit selected States to determine whether the hospice caps were calculated correctly, whether cap overpayments were collected, and whether the Federal share of the collected cap overpayments was properly refunded.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
January 2024 Centers for Medicare and Medicaid Services Audit of Medicaid's Hospice Inpatient and Aggregate Cap Calculations Office of Audit Services WA-24-0025 (W-00-24-31577) 2025