Provider Self-Determined Aggregate Cap Limitation Form Due 02/28/26
CAP reports are self reporting, and are the responsibility of the provider to track due dates and submit the required information.
*Medicare will withhold all payments unless or until the required information is received, timely submission is a priority to prevent delay in revenue.
Hospice cap reporting (Self-Determined Hospice Cap or SDHC) is due annually by February 28th (or 29th in a leap year) following the end of the October 1 -September 30 Medicare fiscal year. This report, filed with your Medicare Administrative Contractor (MAC), details patient counts and claims to determine if the hospice exceeded its annual cap, requiring repayment. The earliest you can file is January 31st after the cap year ends, using your Provider Statistical and Reimbursement (PS&R) data.
If you do not have access to the EIDM system, you should register now. Information on registering can be found on the CMS Website.
Key Deadlines & Timelines:
- Cap Year End: September 30th.
- Earliest Filing: January 31st (3 months after cap year end).
- Final Deadline: February 28th/29th (5 months after cap year end).
- Check Your MAC: Each MAC (like Palmetto GBA, CGS) has specific forms and instructions on their website.
- PS&R Data: You need this data (accessible via EIDM) to prepare the report.
- Timely Filing: Failure to file on time can lead to payment holds.
For New Providers:
- Hospices certified after October 1st have specific timelines; for instance, those certified after Oct 1, 2024, file their first report by Feb 28, 2026 (for the 2025 cap year).
Hospice Quality Reporting Program
https://www.cms.gov/medicare/quality/hospice
Associated FAQ:
Help Guide:
Hospice Tools Financial Reporting Playbook- CAP Report Cost Report Workflow Guidance