The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1689-P) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2019. The proposed HH PPS policies included in the rule would result in a 2.1 percent increase ($400 million) in payments to HHAs in CY 2019 and extends the rural add-on payment for CYs 2019 through 2022.
For CY 2020 payments, CMS proposes to implement an alternative case-mix adjustment methodology, the Patient Driven Groupings Model (PDGM). The PDGM would use 30-day periods, rather than 60-day episodes, and relies more heavily on clinical characteristics and other patient information (e.g., principal diagnosis, functional level, comorbid conditions, referral source, and timing) to place patients into more meaningful payment categories. The PDGM would be implemented in a budget neutral manner on January 1, 2020. To support an assessment of the effects of the proposed PDGM, CMS will provide, upon request, a Home Health Claims-OASIS Limited Data Set (LDS) file to accompany the CY 2019 HH PPS proposed and final rules. The Home Health Claims-OASIS LDS file can be requested by following the instructions on the following CMS website: https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/Data-Disclosures-Data-Agreements/DUA_-_NewLDS.html, and a file layout will be available.
This rule also: proposes regulations text changes regarding certifying and recertifying patient eligibility for Medicare; proposes allowing the cost of remote patient monitoring to be reported by home health agencies on the Medicare cost report form; discusses the implementation of temporary transitional payments for home infusion therapy services to begin on January 1, 2019; solicits comments regarding payment for home infusion therapy services for CY 2021 and subsequent years; proposes health and safety standards for home infusion therapy; and proposes an accreditation and oversight process for home infusion therapy suppliers. The HH QRP section of the rule discusses the Meaningful Measures Initiative and proposes the removal of seven measures. Lastly, in addition to providing an update on the progress towards developing public reporting of performance under the Health Value-Based Purchasing (HHVBP) Model, CMS proposes to refine the HHVBP Model.
Public Comments are due no later than 5pm on August 31, 2018. Instructions on providing public comment can be found in the Summary Section at the beginning of this proposed rule at https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14443.pdf