Description

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1672-P) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2018. The proposed policies included in the rule would result in a 0.4 percent decrease (-$80 million) in payments to HHAs in CY 2018.

For CY 2019 payments, CMS proposes to implement an alternative case-mix adjustment methodology, the Home Health Groupings Model (HHGM). The HHGM would use 30-day periods, rather than 60-day episodes, and rely 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.

For the HH Quality Reporting Program (QRP), CMS is proposing to adopt for the CY 2020 payment determination three measures to meet the requirements of the IMPACT Act and new standardized data elements. To reduce provider burden, CMS is proposing to remove or modify current OASIS items. CMS is also proposing processes for requesting reconsideration of determinations regarding compliance with pay-for-reporting requirements, as well as a process for providing exceptions to these policies and extensions to reporting timeframes. Lastly, CMS is also proposing changes to the Home Health Value-Based Purchasing (HHVBP) Model.

