Medicare Home Health Prospective Payment System Updated for 2022

The Centers for Medicare & Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service prospective payment system for home health (HH) agencies effective Jan. 1, 2022. Key aspects of the final rule include:

  • A one-year delay, until Jan. 1, 2023, of the proposed national expansion of the HH value-based purchasing model to replace the pilot that began in nine states (Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee and Washington) in 2016.
  • A 6.9% increase to the national, standardized 30-day period payment rate HH band from $1,901.12 to $2,031.61 for HH agencies that submit the required quality data.
  • Recalibration of the Patient-driven Groupings Model (PDGM) case-mix weights for the 432 payment groups, using 2020 data.
  • Modification of the HH quality reporting program measures to:
    • Remove an OASIS-based measure: the Drug Education on All Medications Provided to Patient/Caregiver During All Episodes of Care measure.
    • Replace two claims-based measures — the Acute Care Hospitalization During the First 60 Days of Home Health (NQF #0171) measure and the Emergency Department Use without Hospitalization During the First 60 days of Home Health (NQF #0173) measure — with one claims-based measure — the Home Health Within Stay Potentially Preventable Hospitalization measure.
  • Continuation of the 4.36% behavioral adjustment that was implemented in 2020 when the new PDGM case-mix classification system was implemented.
  • Finalization of the proposal to make permanent the blanket waiver related to virtual supervision of home health aides that was granted temporarily for the duration of the COVID-19 pandemic.
  • Implementation of a provision of the Consolidated Appropriations Act that would allow occupational therapists to perform the initial and comprehensive patient assessment.
  • Continuation of the 4.36% payment cut to the standardized 30-day payment rate implemented in 2020 when the new PDGM was adopted.

The CMS continues to review input received on the agency’s plans to define digital quality measures for the HH quality reporting program and the potential use of fast healthcare interoperability resources in support of digital quality measurement. The MHA will provide members with an updated estimated impact analysis soon. Members with questions should contact Vickie Kunz at the MHA.