Home health payments reduced $58 million under CMS proposal

July 7, 2014, update: The proposed rule is now available for viewing online in the Federal Register here.

Payments to home health agencies would decrease $58 million in fiscal year 2015 under changes to the Medicare prospective payment system proposed by the Centers for Medicare & Medicaid Services (CMS). The changes “would foster greater efficiency, flexibility, payment accuracy and improved quality,” according to the federal agency.

The proposed rule will be published in the Federal Register July 7 but is viewable now here. CMS will accept comments on it until Sept. 2.

The proposed decrease reflects the effects of the 2.2 percent home health payment update percentage ($427 million increase) and the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates and the non-routine medical supplies conversion factor ($485 million decrease), CMS says.

Under the CMS proposal:

  • The current narrative requirement of the face-to-face encounter establishing home healthcare eligibility would be eliminated.
  • Only medical records from a patient’s certifying physician or discharging facility would be considered in determining initial eligibility for the Medicare home health benefit.
  • The physician claim for certification/re-certification of eligibility for home health services (not the face-to-face encounter visit) would be considered a non-covered service if the home health agency claim is non-covered because the patient was ineligible for the home health benefit.

The proposal also:

  • Specifies that a face-to-face encounter is required for certifications, rather than initial episodes, and that a certification (versus a re-certification) is generally considered to be any time a new start of care assessment is completed to initiate care.
  • Recalibrates the home health prospective payment case-mix weights by adjusting the weights relative to one another, using calendar year 2013 home health claims data, “to ensure that the case-mix weights reflect the most current utilization and resource data available."

In 2013, about 3.5 million beneficiaries received home health services from nearly 12,000 home health agencies, costing Medicare approximately $18 billion, according to the agency.

For more information, read the proposal.

Topics: Medicare/Medicaid , Regulatory Compliance