This regulation explains how Medicare payment rates for hospice care are calculated in relation to coinsurance liability. The rates are not reduced when a patient owes coinsurance; instead, CMS accounts for estimated average coinsurance collections when setting the base payment rates. This is a Medicare reimbursement methodology rule with no direct applicability to behavioral health, IDD, ABA, or foster care facility licensing or operations.
View official source§ 418.405 Effect of coinsurance liability on Medicare payment. The Medicare payment rates established by CMS in accordance with § 418.306 are not reduced when the individual is liable for coinsurance payments. Instead, when establishing the payment rates, CMS offsets the estimated cost of services by an estimate of average coinsurance amounts hospices collect. [56 FR 26919, June 12, 1991]