CMS-1766-F

CMS issued a final rule [CMS-1766-F] that finalizes routine updates to the home health payment rates for calendar year (CY) 2023, in accordance with existing statutory and regulatory requirements. This rule finalizes a methodology for determining the difference between assumed versus actual behavior change on estimated aggregate expenditures for home health payments as result of the change in the unit of payment to 30 days and the implementation of the Patient Driven Groupings Model (PDGM) case-mix adjustment methodology. Additionally, this rule finalizes a permanent prospective adjustment to the CY 2023 home health payment rates and also finalizes the reassignment of certain diagnosis codes under the PDGM. This final rule establishes a permanent mitigation policy to smooth the impact of year-to-year changes in home health payments related to changes in the home health wage index. Finally, this rule finalizes recalibration of the PDGM case-mix weights and updates the low utilization payment adjustment (LUPA) thresholds, functional impairment levels, comorbidity adjustment subgroups for CY 2023 and the fixed-dollar loss ratio used for outlier payments for CY 2023.