Hospice Knowledge Center
What is the Service Intensity Add-On (SIA)?
The Service Intensity Add-On is a supplemental payment on top of the routine-home-care per-diem for direct patient-care visits by RNs and social workers in the last 7 days of a hospice beneficiary’s life. CMS introduced the SIA to incentivize higher-intensity end-of-life visits.
SIA, in one sentence
The SIA is a per-visit payment for direct patient-care RN and social worker visits during the last 7 days of life, added on top of the RHC per-diem.
Eligibility criteria
The beneficiary is on routine home care level of care, the visit occurs in the last 7 days of life (identified retrospectively), the visit is a direct patient-care visit (not a phone call, not a purely administrative visit), and the visitor is an RN or a social worker.
Payment structure
SIA payment is calculated as the CHC hourly rate multiplied by the direct-care visit hours (subject to a 4-hour daily cap). Confirm the current SIA payment mechanics in the CMS Hospice Wage Index Final Rule for your fiscal year.
Documentation
SIA-eligible visits require documentation showing: (a) direct patient care, (b) visit start and stop times, (c) visitor role. Aide and chaplain visits do not qualify for SIA even if they occur in the last 7 days.
Frequently asked questions
Do phone calls count for SIA?
Are hospice-aide visits SIA-eligible?
How do we know the last 7 days at the time of visit?
Sources & further reading
Educational content only. Not a substitute for your organization’s policies, your medical director’s clinical judgment, or current CMS guidance.
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