The Centers for Medicare & Medicaid Services yesterday released the home health prospective payment system proposed rule for calendar year 2019, which also proposes a major redesign for CY 2020. In CY 2019, the rule would increase net HH payments by 2.1% ($400 million) relative to CY 2018. This includes a 2.7% update to current rates, a productivity adjustment of negative 0.7%, a 0.1% increase related to outlier payments, and a 0.1% decrease due to the new rural payment add-on policy mandated by the Bipartisan Budget Act of 2018. In CY 2020, CMS proposes to implement a new case-mix methodology called the patient-driven groupings model, which would eliminate therapy thresholds in determining payment and change the unit of payment to 30-day periods of care. This budget-neutral implementation of the PDGM was also mandated by the BiBA, and follows a prior iteration put forward by CMS last year, which received extensive feedback from the field. “We are concerned that CMS’s proposed reforms to the HH PPS in CY 2020 appear to be similar to the agency’s prior, flawed iteration of a revised PPS, and will closely evaluate the extent to which they include our recommended changes,” said AHA Executive Vice President Tom Nickels. For CY 2019, the rule also proposes to streamline the HH Quality Reporting Program and the HH Value-Based Purchasing Model; to no longer require the certifying physician to estimate how much longer skilled services are needed when recertifying continued services; and to implement transitional payments for home infusion therapy services; as well as other changes. CMS will accept comments on the proposed rule through Aug. 31.

Related News Articles

Headline
The Centers for Medicare & Medicaid Services May 12 released draft guidance for the third round of negotiations for the Medicare Drug Price Negotiation…
Headline
The AHA April 30 released a report highlighting how hospitals and health systems continue to experience significant financial headwinds that can challenge…
Headline
The AHA today urged the Medicare Payment Advisory Commission to take specific actions on physician fee schedule payments following recommendations the…
Chairperson's File
Public
Rural hospitals and health systems face big challenges, but together — with a unified voice — we can work to ensure people living in rural communities get the…
Headline
The Department of Health and Human Services March 27 announced a series of actions as part of a department-wide restructuring. The department said the moves…
Headline
The AHA March 27 made a series of recommendations to the Physician‐Focused Payment Model Technical Advisory Committee to address barriers to participating in…