CMS overhauls home health payment model: 5 things to know

CMS released its annual Home Health Prospective Payment System rule Oct. 31, which increases home health payments and includes a new value-based payment system that begins in 2020.

Here are five key takeaways from the final rule:

1. Under the final rule, net home health payments will increase by 2.2 percent, or $420 million, in 2019.

2. As mandated by the Bipartisan Budget Act of 2018, CMS will stop using the number of therapy visits provided to determine home health payments in 2020. CMS will implement a new case-mix methodology called the Patient-Driven Groupings Model by January 2020, which will reimburse home health agencies based on patient characteristics rather than the volume of therapy visits.

"The PDGM removes the current incentive to overprovide therapy, and instead, is designed to reflect CMS' focus on relying more heavily on clinical characteristics and other patient information to allow payments to more closely reflect patients' needs," CMS said in a fact sheet about the final rule. 

3. CMS said the new case-mix system, coupled with other changes in the Home Health Quality Reporting Program, will save home health agencies approximately $60 million annually, beginning in 2020.

4. The rule finalizes a proposal to streamline the Home Health Quality Reporting Program by removing seven quality measures, which home health agencies will no longer be required to report data on beginning in 2020.

5. Under the final rule, CMS will implement temporary transitional payments for home health infusion therapy services for 2019 and 2020, as required by the Bipartisan Budget Act. Home health agencies will receive the transitional payments until the new permanent home infusion benefit begins Jan. 1, 2021.

More articles on home health:

CMS rule could add hurdle for home health aides in unions: 6 things to know
Why Intermountain looked 1,400 miles away for its home health partner
Former ER physician, 2 nurses convicted in $13M home health fraud scheme


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