CMS proposes home health payment rule: 6 things to know

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CMS released its annual Home Health Prospective Payment System proposed rule June 28, which recommends expanding a value-based purchasing program. 

Six things to know about the proposed rule:

1. Payment rate update. CMS proposed increasing payments to home health agencies by 1.8 percent in calendar year 2022. CMS estimates this will increase payments to home health agencies by $330 million. CMS noted that home health agencies may see an aggregate 0.1 percent decrease, or $20 million decrease, in payments due to reductions made in the rural add-on payment.

2. Value-based purchasing model expansion. CMS is proposing a nationwide expansion of the home health value-based payment program. CMS first tested the model in January 2016. Today, Medicare-certified home health agencies in nine states participate in the program. CMS said that in its third evaluation report participating providers saw a 4.6 percent improvement in quality scores and average annual savings of $141 million to Medicare.

3. Some pandemic-related changes to home health will remain. CMS also proposed making some changes to home health conditions of participation implemented during the COVID-19 pandemic permanent. In particular, CMS wants to keep the current 14-day on-site supervisory requirement when a patient is receiving skilled nursing services. The proposed rule would allow home health aides to conduct these visits via telehealth, but expects that most should still be conducted on-site during an inpatient visit.

4. Occupational therapists role. CMS proposed permanently allowing occupational therapists to conduct initial assessments for home health Medicare patients when the plan of care includes occupational therapy, physical therapy or speech-language pathology and doesn't include skilled nursing services.

5. Home health quality reporting program. CMS said that home health agencies that do not meet reporting requirements will face a 2 percentage point reduction in their annual update. 

6. Comment period. CMS is accepting comments on the proposed rule through Aug. 27.

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