CMS Releases 2018 Home Health Proposed Rule

Posted on August 02, 2017

On July 25, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule to update the Medicare fee-for-service (FFS) home health (HH) prospective payment system (PPS) for 2018. Highlights of the proposed rule include:

  • An overall 1.62 percent rate increase from the current $2,989.97 to $3,038.43
  • A change in case-mix calculations and in the unit of payment from 60-day to 30-day episodes of care, beginning Jan. 1, 2019  (additional information is provided below)
  • Expiration of the 3 percent add-on for services provided in rural areas
  • Implementation of the last year of the 3-year reduction to the national, standardized, 60-day episode payment rates of 0.97 percent to recoup what the CMS believes to be overpayments for nominal case-mix growth between 2012 and 2014
  • Changes to the HH quality reporting program (QRP) requirements

The proposed reconfiguration of the HH PPS noted above includes a new case-mix methodology, known as the home health groupings model (HHGM), and a reduction in the unit of payment from a 60-day to a 30-day episode of care. The proposed HHGM would take effect Jan. 1, 2019, and would rely on clinical characteristics and other patient information, rather than on the current nine therapy thresholds, to assign patients into payment categories based on:

  • Admission source
  • Principal HH diagnosis
  • Functional levels
  • Comorbidity adjustment

Featured in the Monday Report. Click to view the full edition.In the next few weeks, the MHA will provide additional detail regarding the HH proposed rule, including a facility-specific impact analysis. The association will also make its draft comments available for members’ use in submitting their own comments to the CMS by Sept. 25. The CMS is expected to release a final rule by Nov. 1 for the Jan. 1, 2018, effective date. Members with questions should contact Vickie Kunz at the MHA. 

Tags: home health, CMS, PPS, FFS

Posted in: Member News

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