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Medicare spending outside the per diem during a hospice election
Medicare Part A, B, or D payments for services furnished to a beneficiary during a hospice election but billed outside the per diem — approximately $2.8 billion in FY2024 and a primary SSVI scoring input.
Non-hospice spending is Medicare payment for Part A, Part B, and Part D items or services furnished to a beneficiary while that person is under a hospice election, outside the hospice per diem. It is care Medicare paid for that arguably should have been covered under the hospice benefit for the terminal illness and related conditions.
When a beneficiary elects hospice, the hospice per diem is meant to cover virtually all care related to the terminal prognosis, so separate Medicare payment for related services signals possible unbundling or cost-shifting. In FY2024, Medicare paid over $2.1 billion in Part A and Part B spending and $813 million in Part D spending during hospice elections, roughly $2.8 billion in total, and non-hospice spending has increased about 160% since FY2020 (CMS FY2027 Hospice proposed rule fact sheet)[1]. CMS folds this spending into the finalized Service and Spending Variation Index (SSVI), a nine-measure claims-based composite that flags hospices with concerning utilization and non-hospice spending patterns for oversight and public transparency (proposed in CMS-1851-P, April 2026; finalized in CMS-1851-F, July 30, 2026, with no substantive methodology changes; CMS FY2027 final rule fact sheet, https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2027-hospice-wage-index-payment-rate-update-hospice-quality-reporting-program). High non-hospice spending under a hospice's patients is one of the strongest signals CMS uses to identify programs whose bundling practices merit review.
Non-hospice spending is a named, measured, and publicly comparable indicator as of July 2026, when CMS began publishing provider-level SSVI scores on the CMS Hospice Center webpage. A program with high non-hospice spending carries a visible and quantified compliance profile against which peer comparisons are now public. The care-planning decisions that determine whether related conditions, drugs, and services are covered under the per diem or billed outside it are the same decisions that produce or suppress the non-hospice spending sub-score in the SSVI. Dual-eligible patients add complexity because Medicare and Medicaid coordination can obscure the boundary of what belongs inside the hospice benefit. The $2.8 billion in FY2024 non-hospice spending and its 160% increase since FY2020 have driven the regulatory attention that produced the SSVI and the mandatory election statement addendum (see SSVI Score; Relatedness Determination).
It is Medicare Part A, B, or D payment for services provided to a patient during a hospice election but billed outside the hospice per diem (CMS FY2027 proposed rule fact sheet)[1].
About $2.8 billion in FY2024, combining roughly $2.1 billion in Parts A and B with $813 million in Part D (CMS FY2027 proposed rule fact sheet)[1].
Because it has grown about 160% since FY2020 and is now incorporated into the finalized SSVI, a public scoring tool used to identify hospices for oversight (CMS FY2027 final rule fact sheet)[2].
Vitalis Care is the end-of-life care app that helps hospices deliver compassionate care — while staying on top of schedules, field operations, documentation, compliance, and reimbursement.
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