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Home Health Agency (HHA) Center

  • CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value Based Purchasing Model; and Home Health Quality Reporting Requirements: The Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1625-F) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2016.  In the CY 2016 final rule, CMS implements the third year of the four year phase-in of the rebasing adjustments to the HH PPS payment rates as required by the Affordable Care Act.  In addition, CMS will decrease the national, standardized 60-day episode payment amount by 0.97 percent in each year for CY 2016, CY 2017, and CY 2018 to account for nominal case-mix growth between CY 2012 and CY 2014.  CMS also provides an update to the Home Health Quality Reporting Program. Lastly, CMS is implementing a Home Health Value-Based Purchasing (HHVBP) model effective for CY 2016. CMS estimates that the net impact of the payment provisions of the final rule will result in a decrease of 1.4 percent ($260 million) in Medicare payments to HHAs for CY 2016.  Along with the payment update, CMS is revising the ICD-10-CM translation list and adding certain initial encounter codes to the HH PPS Grouper based upon revised ICD-10-CM coding guidance
  • Report to Congress on the Medicare Home Health Study: An Investigation on Access to Care and Payment for Vulnerable Patient Populations
    Section 3131(d) of the Affordable Care Act required that CMS conduct a study on home health agency costs involved with providing ongoing access to care to low-income Medicare beneficiaries or beneficiaries in medically under served areas, and in treating beneficiaries with varying levels of severity of illness (“vulnerable patient populations”) and submit a report to Congress.  View the report to Congress and Appendix in the links below.
  • Proposed Conditions of Participation The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule ( CMS-3819-P - Opens in a new window ) that would modernize Medicare’s Home Health Agency Conditions of Participation to ensure safe delivery of quality care to home health patients. The proposed regulation reflects the most current home health agency practices by focusing on the care provided to patients and the impact of that care on patient outcomes. This proposed regulation focuses on assuring the protection and promotion of patient rights; enhances the process for care planning, delivery, and coordination of services;  streamlines regulatory requirements; and builds a foundation for ongoing, data-driven, agency-wide quality improvement.

Home Health, Hospice and DME Open Door Forum

Physician Certification of Patient Eligibility for the Medicare Home Health Benefit

  • MLN Matters® SE1436: Certifying Patients for the Medicare Home Health Benefit
  • MLN Connects™ National Provider Call - Certifying Patients for the Medicare Home Health Benefit (December 16, 2014). This MLN Connects™ National Provider Call provided an overview of certifying patient eligibility for the Medicare home health benefit. This included a summary of the new requirement for HHAs to obtain documentation from the certifying physician's and/or the acute/post-acute care facility's medical record for the patient that served as the basis for the certification of patient eligibility, which was finalized in the Calendar Year 2015 Home Health Prospective Payment System (HH PPS) final rule (CMS-1611-F) and effective for episodes of care beginning on or after January 1, 2015. For links to the presentation, examples, and transcripts, visit this MLN Connects™ National Provider Call web page.
  • MLN Matters® MM8444: Clarification of the Definition of "Confined to the Home"

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