Home Health PPS

November 21, 2024

AT A GLANCE

The Centers for Medicare & Medicaid Services (CMS) Nov. 1 issued its calendar year (CY) 2025 final rule for the home health (HH) prospective payment system (PPS). New policies will generally be effective Jan. 1, 2024

Key Highlights

The final rule will:

Increase net HH payments by an estimated 0.5%, or $85 million, after all policy changes, compared to CY 2024. This increase results from a net 2.7% market basket update, a 1.8% downward behavioral adjustment and a 0.4% reduction to outlier payments.
Adopt new core-based statistical areas (CBSAs) for wage indexes.
Require HH agencies (HHAs) 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 (CoP) that will require HHAs to develop, implement and maintain a “patient acceptance to service” policy that is consistently applied to each prospective patient referred for HH care.
Adopt requirements for long-term care (LTC) facilities to report certain data related to respiratory elements as part of their infection control programs.