CMS finalizes home health payment rule for 2020: 8 things to know

CMS issued a final rule Oct. 31 that increases home health payments for 2020. 

Eight takeaways from the final rule:

1. Next year, net Medicare payments to home health agencies will increase by 1.3 percent, or $250 million.

2. The final rule sets forth the implementation of an alternate case-mix adjustment methodology called the Patient-Driven Groupings Model. The methodology, finalized last year, is mandated by the Bipartisan Budget Act of 2018.

3. In implementing the new model, CMS will use 30-day care periods rather than 60-day episodes of care as the payment unit. 

4. CMS will stop using the number of therapy visits provided to determine payment to home health agencies and instead rely more on clinical characteristics and other patient information, such as diagnosis and functional level, to determine reimbursement.

5. Therapist assistants, as well as therapists, will be allowed to provide maintenance therapy under the Medicare home health benefit.  

6. The Transfer of Health Information to Provider-Post-Acute Care and Transfer of Health Information to Patient-Post-Acute Care quality measures will be added to the Home Health Quality Reporting Program. 

"These finalized measures are designed to improve patient safety by ensuring that the patient's medication list is provided to a provider and the patient as part of the discharge process," CMS said in a news release

7. The Improvement in Pain Interfering with Activity Measure will be removed  from the Home Health Quality Reporting Program. CMS said it is removing the quality measure "to mitigate any potential unintended overprescription of opioid medications inadvertently driven by this measure."

8. The final rule includes a comment period related to home infusion therapy. CMS will accept public comments on criteria that can be considered to allow coverage of additional drugs for home infusion therapy through Dec. 30.


More articles on healthcare finance: 

For-profit hospital stock report: Week ending Nov. 1
Hospitals prepare for looming Medicaid DSH cuts
Study links prior authorizations to treatment delays

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