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Home Health Agency (HHA) Center

  • The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1648-P) that would update the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2017.  The proposed updates to the HH PPS rates include implementing the final year of the four year phase-in of the rebasing adjustments to the national, standardized 60 day episode payment rates, the national per-visit rates, and the non-routine medical supplies (NRS) conversion factor as required by law. In addition, this proposed rule would reduce the national, standardized 60-day episode payment rates by 0.97 percent in CY 2017 to account for nominal case-mix growth between CY 2012 and CY 2014 (i.e., case-mix growth that does not reflect changes in patient acuity), which was not accounted for in the rebasing adjustments finalized in the CY 2014 HH PPS final rule. The CY 2017 proposed rule would result in a 1.0 percent decrease (-$180 million) in payments to HHAs.  CMS is also proposing changes to the methodology used to calculate outlier payments.  As required by the Consolidated Appropriations Act of 2016, CMS proposes changes in payment for Negative Pressure Wound Therapy (NPWT) performed using a disposable device for patient’s under a home health plan of care.  CMS also proposes an update to the Home Health Quality Reporting Program. Lastly, in addition to providing an update on the progress towards developing public reporting of performance under the HH VBP Model, CMS proposes several changes and improvements related to the model.

  • 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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