Per Diem Blending

Per diem blending is the weighted-average daily rate a hospice actually realizes once its patient days are distributed across the two Routine Home Care tiers and the other levels of care. It is the effective, mix-driven rate that sits below the published per-diem rates.

Medicare pays four distinct per diems, and for FY2026 they are $230.83 for RHC days 1–60, $181.94 for RHC day 61+, $1,674.29 per day for Continuous Home Care ($69.76 per hour), $532.48 per day for Inpatient Respite Care, and $1,199.86 per day for General Inpatient Care (CMS FY2026 Hospice Wage Index final rule fact sheet)^[1]. A hospice's blended rate is the total of those payments divided by total patient days, so the mix of tiers and levels determines the result. Since the overwhelming majority of hospice days are RHC, the split between the higher and lower RHC tiers dominates the blend: a census skewed toward day 61+ pulls the blended rate toward $181.94, while a steady flow of new admissions keeps more days at $230.83. Wage-index adjustment, the Service Intensity Add-on, and any GIP, CHC, or respite days shift the blend further. The FY2027 final rule (CMS-1851-F, July 30, 2026) raises all four per diems by 2.3% (CMS FY2027 final rule fact sheet)^[2].

Published per-diem rates are the ceiling for each level and tier, not the revenue a hospice realizes per day; the realized figure is the blend, which moves with census composition. A program whose length of stay drifts upward without a corresponding increase in new admissions shifts a larger proportion of days into the RHC day 61+ tier at $181.94, lowering the blend without any change to the fee schedule. CHC and GIP days pay several times the RHC rate and pull the blend upward when appropriately utilized and documented; SIA capture has the same directional effect within the RHC base. The blended per diem is where payer mix and clinical utilization decisions appear as a single dollar figure.