CMS releases proposed home health payment rule: 9 things to know

CMS issued its proposed home health payment rule for 2018 and 2019.

Here are nine things to know about the proposed rule.

1. CMS said the proposed rule would update 2018 Medicare payment rates and the wage index for Medicare home health agencies.

2. The proposed rule also includes changes to the home health prospective payment system case-mix adjustment methodology. Specifically, the unit of payment would shift from 60-day episodes of care to 30-day periods of care, according to the agency. The changes would take effect Jan. 1, 2019.

3. Additionally, proposals for the Home Health Value-Based Purchasing Model and the Home Health Quality Reporting Program are part of the proposed rule.

4. Under the proposed rule, CMS estimates Medicare payments to home health agencies would be reduced by 0.4 percent, or $80 million, in 2018.

5. The estimated decrease is based on various factors. These include a $190 million increase to the home health payment update; a $170 million decrease due to an adjustment to the national, standardized 60-day episode payment rate to account for nominal case-mix growth; and a $100 million decrease due to the sunset of the rural add-on provision.

6. More specifically, the proposed rule calls for a 1 percent home health payment update percentage for home health agencies that submit the required quality data for the Home Health Quality Reporting Program, and a 0.97 percent decrease to the national, standardized 60-day episode rate in 2018 to account for nominal case-mix growth from 2012 to 2014, according to CMS.

7. As far as the changes to the home health prospective payment system case-mix adjustment methodology for 2019, CMS said a change to the unit of payment from 60-day episodes of care to 30-day periods of care is slated for implementation beginning on or after Jan. 1, 2019. The agency noted the proposed rule, however, does not include a change to the split percentage payment approach along with proposing to change the unit of payment.

8. CMS said the proposed case-mix methodology changes, or the home health groupings model, "rely more heavily on clinical characteristics and other patient information to place 30-day periods of care into meaningful payment categories," and "eliminates therapy service use thresholds that are currently used to case-mix adjust payments under the" home health prospective payment system.

9. CMS is currently soliciting comments on the proposed rule. View the full proposed rule in the Federal Register here.

 

© Copyright ASC COMMUNICATIONS 2021. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.