The rumors are true! The hospice cost report has been completely overhauled, per CMS instructions.

The basic idea of form 1984-14 is that it is now structured around “Levels of Care” (LOCs), by which all census information and direct care expenses need to be classified. At the end of the day, the cost report software calculates what the costs were for each LOC.

From here on in, any hospice should try to re-do its chart of accounts so that direct care expenses are divided by these four levels of care. That will make the facility’s cost report going forward easy to prepare.

Your PS&R report already shows census information divided by LOCs as follows:

1. Continuous Home Care – number of patient days for patients receiving eight+ hours of predominantly nursing care at home daily. “Home” can also mean a nursing home, if that is where the patient lives.
2. Routine Home Care – number of patient days for patients at home not receiving continuous home care. As above, “Home” can also mean a nursing home.
3. Inpatient Respite Care – number of patient days for patients sent to an inpatient care facility such as a hospital, nursing home (skilled nursing facility), or actual hospice building, to give respite to their caregivers. An example would be that the caregivers are going on vacation for a few days.
4. General Inpatient Care – number of patient days for patients who receive care in an inpatient facility such as a hospital, nursing home (skilled nursing facility), or actual hospice building. This type of care would be for pain control or symptom management (either acute or chronic) which cannot be managed in other settings.

Direct care expenses are any expenses which result from hands-on patient care. These would include, for example, RN salaries, therapists (PT, OT, and Speech), and medical supplies expenses. Any of the above, plus any other similar expense (divided by cost centers on the A series worksheets), needs to be sub-divided by LOCs so that RN salaries for Continuous Home Care would be classified separately from RN salaries for General Inpatient Care, for example.

Each LOC has its own worksheet:  A-1 for Continuous Home Care, A-2 for Routine Home Care, A-3 for Inpatient Respite Care, and A-4 for General Inpatient Care. To continue the above example, RN Continuous Home Care salaries would go in the salary column of worksheet A-1 on the RN line. RN General Inpatient Care salaries would go in the salary column of worksheet A-4 on the RN line.