The Centers for Medicare and Medicaid Services (CMS) recently released a final rule to update the home health (HH) prospective payment system (PPS) for calendar year (CY) 2024. The 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.
Highlights of the final rule which takes effect Jan. 1, 2024, include:
- A negative 2.89% behavioral offset to achieve budget neutrality due to the transition to the Patient-driven Groupings Model (PDGM). This is half of the estimated permanent adjustment of 5.78%.
- A 30-day standard payment rate of $2,038.13, for home health agencies that submit the required quality data. This is a 1.4% increase from the current rate after the 3% market basket 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 adoption of two new measures to the HH quality reporting program with the CMS finalizing the removal of two measures and public reporting of four measures.
- 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%.
The MHA will provide an updated impact analysis of the final rule in the near future.
Members with questions should contact Vickie Kunz at the MHA.
The Centers for Medicare & Medicaid Services (CMS) recently released the proposed rule to update the Medicare fee-for-service (FFS) home health (HH) prospective payment system (PPS) effective Jan. 1, 2023. Highlights of the proposal include:
- A net 6.25% decrease in the national, 30-day standardized payment amount after the estimated 6.9 percentage point cut to achieve budget-neutrality for the Patient-Driven Groupings Model on a prospective basis. The proposed payment rate is $1,904.76, down from the current $2,031.64 for HHs that comply with HH quality reporting program (QRP) requirements.
- An increase in the fixed-dollar loss ratio from the current 0.40 to 0.44.
- A permanent 5% cap on wage index decreases to mitigate significant payment reductions from wage index changes.
- Comment solicitation regarding the data collection on the use of remote services at the individual beneficiary level, which would allow the CMS to analyze the characteristics of the beneficiaries using remote services and potential for identifying social determinants of health that impact use of remote services.
- Ending the suspension of data submission for non-Medicare/non-Medicaid patients. HH agencies would be required to submit all-payer OASIS data for purposes of the HH QRP beginning with the 2025 program year.
- Changes to the Expanded HH value-based purchasing (VBP) model, including definitions for the baseline and model year, changing the baseline year from 2019 to 2022 for existing HH agencies and modifying the model year from 2019 to 2022 beginning in 2023.
- Seeking feedback on development of health equity measures for the HH QRP and potential future application of health equity in the Expanded HH VBP model’s scoring and payment methodologies.
The MHA will provide members with an estimated impact analysis within the next few weeks and share draft comments prior to the Aug. 16 deadline. The MHA encourages members with HH operations to review the impact of the proposed rule on their operations and submit comments to the CMS. Members that have not received impact analyses in the past for affiliated, free-standing HH agencies are encouraged to provide the agency’s CMS certification number (also known as Medicare provider number), agency name, and federal information processing standards code to receive an estimated impact analysis in the future. Members are encouraged to forward this information and questions to Vickie Kunz at the MHA.