The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1689-P) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2019. The proposed HH PPS policies included in the rule would result in a 2.1 percent increase ($400 million) in payments to HHAs in CY 2019 and extends the rural add-on payment for CYs 2019 through 2022.
For CY 2020 payments, CMS proposes to implement an alternative case-mix adjustment methodology, the Patient Driven Groupings Model (PDGM). The PDGM would use 30-day periods, rather than 60-day episodes, and relies more heavily on clinical characteristics and other patient information (e.g., principal diagnosis, functional level, comorbid conditions, referral source, and timing) to place patients into more meaningful payment categories. The PDGM would be implemented in a budget neutral manner on January 1, 2020. To support an assessment of the effects of the proposed PDGM, CMS will provide, upon request, a Home Health Claims-OASIS Limited Data Set (LDS) file to accompany the CY 2019 HH PPS proposed and final rules. The Home Health Claims-OASIS LDS file can be requested by following the instructions on the following CMS website:
https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/Data-Disclosures-Data-Agreements/DUA_-_NewLDS.html, and a file layout will be available.
This rule also: proposes regulations text changes regarding certifying and recertifying patient eligibility for Medicare; proposes allowing the cost of remote patient monitoring to be reported by home health agencies on the Medicare cost report form; discusses the implementation of temporary transitional payments for home infusion therapy services to begin on January 1, 2019; solicits comments regarding payment for home infusion therapy services for CY 2021 and subsequent years; proposes health and safety standards for home infusion therapy; and proposes an accreditation and oversight process for home infusion therapy suppliers. The HH QRP section of the rule discusses the Meaningful Measures Initiative and proposes the removal of seven measures. Lastly, in addition to providing an update on the progress towards developing public reporting of performance under the Health Value-Based Purchasing (HHVBP) Model, CMS proposes to refine the HHVBP Model.
Abt Associates convened a Technical Expert Panel (TEP) on February 1, 2018 to collect perspectives, feedback, and recommendations from a wide variety of industry experts and representatives regarding the public comments received on the Home Health Groupings Model (HHGM), as described in the CY 2018 Home Health Prospective Payment System (HH PPS) Proposed Rule (82 FR 35270). The TEP materials are now available for download. If you have any questions or comments on the TEP materials, please email Abt Associates at HomeHealth@abtassoc.com.
This MLN Connects™ National Provider Call will provide an overview of the Home Health Groupings Model (HHGM). This technical report describes efforts to reassess the current HH PPS and develop large-scale payment methodology changes. During this call, CMS experts introduce the HHGM model. A question and answer session follows the presentation. Prior to the call, participants are encouraged to review the technical report. For links to the free registration, visit this MLN Connects® National Provider Call web page.
This technical report describes efforts to date on reassessing the current Home Health Prospective Payment System (HH PPS) and developing potentially large-scale payment methodology changes to better align payment with patient needs, to address payment incentives and vulnerabilities in the current system, and to respond to the concerns laid out in the prior Home Health Study Report to Congress, required by section 3131(d) of the Affordable Care Act, and from the Medicare Payment Advisory Commission. The report specifically discusses one potential model called the Home Health Groupings Model. Any questions or comments about this Technical Report should be sent to: HomeHealth@abtassoc.com.
HHGM ICD-9-CM Codes for Clinical Groupings and Comorbidities [ZIP, 290KB]
Report to Congress on the Medicare Home Health Study: An Investigation on Access to Care and Payment for Vulnerable Patient Populations Section 3131(d) of the Affordable Care Act required that CMS conduct a study on home health agency costs involved with providing ongoing access to care to low-income Medicare beneficiaries or beneficiaries in medically under served areas, and in treating beneficiaries with varying levels of severity of illness (“vulnerable patient populations”) and submit a report to Congress. View the report to Congress and Appendix in the links below.
MLN Connects™ National Provider Call – Certifying Patients for the Medicare Home Health Benefit (December 16, 2014). This MLN Connects™ National Provider Call provided an overview of certifying patient eligibility for the Medicare home health benefit. This included a summary of the new requirement for HHAs to obtain documentation from the certifying physician’s and/or the acute/post-acute care facility’s medical record for the patient that served as the basis for the certification of patient eligibility, which was finalized in the Calendar Year 2015 Home Health Prospective Payment System (HH PPS) final rule (CMS-1611-F) and effective for episodes of care beginning on or after January 1, 2015. For links to the presentation, examples, and transcripts, visit this MLN Connects™ National Provider Call web page.
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