Home Health PPS

July 22, 2024

AT A GLANCE

On June 26, the Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2025 proposed rule for the home health (HH) prospective payment system (PPS). Comments are due Aug. 26, and a final rule is expected around Nov. 1. New policies would generally be effective Jan. 1, 2025.

Key Highlights

The proposed HH rule would:

Reduce net HH payments by an estimated 1.7% or $280 million, after all policy changes, compared to estimated CY 2024 payments. This reduction includes:
- A permanent behavioral adjustment (applied to the 30-day episode payment rate only) that is expected to reduce payments by 3.6%;
- A 3.0% market basket update, reduced by a negative 0.5% productivity adjustment; and
- An estimated 0.6% decrease in payments due to changes in outlier payments.
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.

The proposed rule also contains a provision that would adopt requirements for long term care (LTC) facilities to report certain data elements related to respiratory elements as part of their infection control programs.