The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule to update the home health (HH) prospective payment system (PPS) for calendar year (CY) 2024. The proposed rule includes updates to the Medicare fee-for-service (FFS) HH PPS payment rates based on changes by the CMS and those previously adopted by Congress.
The proposed updates include:
- A negative 5.653% behavioral offset to achieve budget neutrality due to the transition to the Patient-Driven Groupings Model (PDGM).
- A 30-day standard payment rate of $1,974.38, which is a 1.81% decrease from the current rate after the 3% marketbasket update is reduced for the negative behavioral adjustment and budget neutrality.
- Recalibration of the PDGM case-mix weights, low utilization payment adjustment thresholds, functional levels and comorbidity adjustment subgroups.
- Updates to the expanded HH value-based purchasing program previously expanded to all 50 states. All HH agencies certified before Jan. 1, 2022, will have a reduction or an increase to their Medicare payments by up to 5% based on their performance on specified quality measures beginning in CY 2025.
- The addition of two new measures to the HH quality reporting program.
- Payment rates for the administration of Home Intravenous Immune Globulin items and services.
- Creation of the Hospice Informal Dispute Resolution and special focus programs.
- Changes to durable medical equipment, prosthetics, orthotics and supplies outlined by the Consolidated Appropriations Act of 2023.
- A decrease in the labor-related share of the HH 30-day period standard rate from 76.1% in 2023 to 74.9%.
- A request for information on the use of home health aides.
Comments on the proposed rule are due to the CMS Aug. 29 and can be submitted electronically by using the website’s search feature to search for file code “1780-P.” The MHA will provide an estimated impact analysis of the proposed rule within the next few weeks.
Members with questions should contact Vickie Kunz at the MHA.