Home Health PPS

Key Highlights

The rule would, among other proposals:

• Reduce net HH payments by an estimated $280 million (1.7%) in CY 2025, relative to CY 2024, based upon:
  • A 3.0% market basket increase, reduced by a 0.5% productivity adjustment.
  • A 3.6% cut to payments resulting from a behavioral adjustment designed to achieve budget neutrality due to the transition to the Patient-driven Groupings Model (PDGM).
  • An adjustment to the fixed-dollar loss ratio for outlier payments that would result in an estimated 0.6% decrease in payments.
• Adopt new core-based statistical areas (CBSAs) for purposes of wage indexes.
• Require HH agencies to report four new patient assessment items in the HH agency Outcome and Assessment Information Set (OASIS) under the social determinants of health category beginning with CY 2027.
• Add a new standard within the Medicare Conditions of Participation that would require HH agencies to develop, implement, and maintain a patient acceptance to service policy that is applied consistently to each prospective patient referred for home health care.
• Adopt requirements for long-term care (LTC) facilities to report certain data elements related to respiratory elements as part of their infection control programs.