Traditional MedicareReimbursementHigh impact
New Two-Tier Routine Home Care (RHC) Rates and End of Life Service Intensity
Illinois Medicaid - HFS·IL · Palliative Care·Provider Notice
Effective date
Jan 1, 2016
We identified it
Jun 20, 2026
Summary
Effective January 1, 2016, hospice providers must use a two-tier payment system for routine home care (days 1-60 at higher rate, days 61+ at lower rate) and can now bill for Service Intensity Add-on payments for RN/social worker visits during the last 7 days of life. New HCPCS codes G0299 and G0155 with specific revenue codes must be used for end-of-life services.
Action Required
Immediately: Update billing system to implement two-tier RHC payment structure (revenue code 0651) with automatic day counting from hospice election date. Configure system to bill G0299 with revenue code 055X for RN services and G0155 with revenue code 056X for social worker services during last 7 days of life, limited to 16 units (4 hours) per day maximum. Update claims processing to require discharge status 'Death' for SIA billing. Train billing team on new error codes K16 and K17 for claim troubleshooting.