Hospice Cap Self-Reporting

Each year hospices must submit their Self-Determined Hospice Cap (SDHC) Report. The Centers for Medicare & Medicaid Services (CMS) requires the submission of this report to determine the early impact of the aggregate cap on overall reimbursement (Reference: Medicare Benefit Policy Manual, CMS Pub. 100-02, Chapter 9, Section 90, (PDF). This applies to both freestanding and hospital-based hospices for which Palmetto GBA processes claims. 

See Hospice Caps for information on the Aggregate Cap on Overall Reimbursement.

The SDHC Report is for the cap year (12-month period: October 1 to September 30) and is due no later than five months after the end of the cap year.

The form for the current year SDHC Report is attached below. 

Instructions for completing the form and ordering PS&R reports are as follows: 

• Instruction — SDHC form (PDF)
• Instruction — Ordering PS&R Reports (PDF)

What to Submit

• Only the one-page SDHC Report
• Ensure it is signed by an authorized official  
• Do notinclude supporting documentation 

When to Submit
In January or February as: 

• PS&R Reports must include claims processed at least three months after the end of the cap year
• Report must be filed no later than five months after end of the cap year (February 28/29)

How to Submit
The SDHC Report can be sent by email or mail. Email is the preferred method and offers the quickest acknowledgment of receipt. (Only send by one method.)

Email to: HospiceCap@palmettogba.com. In the subject line include only the provider number. 

If Not Submitted Timely
If the SDHC Report is not received by the due date, a past due letter will be sent within seven days and payments will be suspended at 100 percent.

If unable to file the SDHC form timely, a hospice can request payment suspension at 50 percent. This request must be made in writing and submitted before the due date of the SDHC Report.

If there are questions on submitting the SDHC Report, please email them to us at HospiceCap@Palmettogba.com. 

Repay an Overpayment 
If line 5 of the SDHC Report reflects payments in excess of the aggregate cap amount — an overpayment must be repaid. Submit a check made payable to Palmetto GBA for the full amount (or the first month’s payment if requesting an ERS) and mail to either address below. Also, payment can be submitted electronically via eCheck. To register and utilize eCheck, go to Palmetto GBA’s eServices Portal.

If a check or eCheck is not submitted, Medicare payments will be withheld to collect the amount due. 

Requesting an Extended Repayment Schedule (ERS)
If unable to repay the overpayment in full, one may submit a Request for Extended Repayment Schedule (PDF). This link provides: 1) instructions for completing and submitting a request for extended repayment, 2) how to submit the first payment, and 3) the documentation to submit.