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Home Health Agency (HHA) Center

Spotlights
  • The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule CMS-1611-P to update Medicare's Home Health Prospective Payment System (HH PPS) payment rates and wage index for calendar year (CY) 2015.  As required by Section 3131(a) of the Affordable Care Act, this rule implements the second year of the four-year phase-in of the rebasing adjustments. Payments to home health agencies (HHAs) are estimated to decrease by approximately 0.30 percent, or -$58 million in CY 2015. This proposed rule also proposes changes to: simplify the face-to-face encounter regulatory requirements; update the HH PPS case-mix weights; revise the home health quality reporting program requirements; simplify the therapy reassessment timeframes; revise the Speech-Language Pathology (SLP) personnel qualifications; and limit the reviewability of the civil monetary penalty provisions.  Finally, this proposed rule also discusses Medicare coverage of insulin injections under the HH PPS, the delay in the implementation of ICD-10-CM, and solicits comments on a HH value-based purchasing (HH VBP) model.  View the fact sheet.
  • MLN Matters® SE1405: Documentation Requirements for Home Health Prospective Payment System (HH PPS) Face-to-Face Encounter.  The majority of HH PPS improper payments are due to “insufficient documentation” errors. “Insufficient documentation” errors occur when the medical documentation submitted is inadequate to support payment for the services billed or when a specific documentation element that is required is missing. Most “insufficient documentation” errors for HH PPS result from claims where the narrative portion of the face-to-face encounter document does not sufficiently describe how the clinical findings from the encounter support the beneficiary’s homebound status and the need for skilled services. This article describes the face-to-face encounter requirements, with a focus on the narrative requirement, and provides several examples of both inappropriate narratives and appropriate narratives. We encourage both HHAs and physicians to review this article to ensure that they are complying with the face-to-face encounter requirements as part of the certification of eligibility for home health services.  
  • Jimmo v. Sebelius Settlement Agreement – Program Manual Clarifications (Fact Sheet)
    As explained in the previously-issued Jimmo v. Sebelius Settlement Agreement Fact Sheet (see Downloads section on the SNF PPS web page), the Centers for Medicare & Medicaid Services (CMS) is issuing revised portions of the relevant program manuals used by Medicare contractors.  For additional information, please see the Jimmo v. Sebelius Settlement Agreement – Program Manual Clarifications (Fact Sheet) [PDF, 416KB] .  The Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo vs. Sebelius can be found in CR 8458 and in associated MLN Matters Article, MM8458.
  • The Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1450-F) to update Medicare's Home Health Prospective Payment System (HH PPS) payment rates and wage index for calendar year (CY) 2014. As required by Section 3131(a) of the Affordable Care Act, this rule implements rebasing adjustments, with a 4-year phase-in, to the national, standardized 60-day episode payment rates; the national per-visit rates; and the NRS conversion factor. Payments to home health agencies (HHAs) are estimated to decrease by approximately 1.05 percent, or -$200 million in CY 2014, reflecting the combined effects of the 2.3 percent HH payment update percentage ($440 million increase), the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates, and the NRS conversion factor ($520 million decrease), and the effects of ICD-9-CM HH PPS Grouper refinements ($120 million decrease). This final rule also discusses our transition to ICD-10-CM coding, establishes home health quality reporting requirements for CY 2014 payment and subsequent years, specifies that Medicaid responsibilities for home health surveys be explicitly recognized in the State Medicaid Plan, and revises the methodology for calculating state Medicaid programs’ fair share of Home Health Agency (HHA) survey costs.

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Home Health Face-to-Face

Therapy and Skilled Nursing

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