The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule to update the home health (HH) prospective payment system (PPS) for calendar year (CY) 2025. The rule includes updates to the Medicare fee-for-service HH PPS payment rates based on changes by the CMS and those previously adopted by Congress.
Highlights of the proposed rule, which takes effect Jan. 1, 2025, include:
- A negative 4% adjustment to base payment rates to achieve budget neutrality following the transition to the Patient-driven Groupings Model (PDGM).
- A 30-day standard payment rate of $2,008.12 ,down 1.5% from the current $2,038.13, for HH agencies that submit the required quality data.
- Updating core-based statistical areas for wage index purposes, consistent with recent fiscal year 2025 proposed rules.
- Recalibrating the PDGM case-mix weights, low utilization payment adjustment thresholds, functional levels and comorbidity adjustment subgroups.
- Revising the fixed dollar loss ratio from 0.27 to 0.38, reducing outlier payments.
- Requiring HH agencies to report four new patient assessment items in the HH agency Outcome and Assessment Information Set under the social determinants of health category, beginning CY 2027.
- Adding a new standard within the Medicare Conditions of Participation requiring HH agencies to develop, implement and maintain a patient acceptance to service policy that is applied consistently to each prospective patient referred for HH care.
- Requiring long-term care facilities to report respiratory illness data as part of their infection prevention and control programs. The CMS proposes that facilities would electronically report weekly data on COVID-19, influenza and RSV in a standardized format through the National Healthcare Safety Network.
- Requesting information on:
- HH quality reporting program measure concepts under consideration for future years.
- Future performance measure concepts for the expanded HH value-based purchasing model.
- Rehabilitative therapists conducting the initial and comprehensive assessment.
- Plan of care development and scope of services HH patient receive.
Members are encouraged to review the proposed rule and contact Vickie Kunz by Aug. 19 regarding issues. Comments are due to the CMS Aug. 26, 2024, and can be submitted electronically. The MHA will provide an estimated impact analysis in the near future.
Members with questions should contact Vickie Kunz at the MHA.
