Regulation No.
CMS-1625-P and CMS-1625-CN
CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value Based Purchasing Model; and Home Health Quality Reporting Requirements
Publication Date
CY 2016
Display Date
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2016. In the CY 2016 proposed rule, CMS is implementing the third year of the four year phase-in of the rebasing adjustments to the HH PPS payment rates required by the Affordable Care Act. In addition, CMS is proposing to decrease the national, standardized 60-day episode payment amount by 1.72 percent in each year for CY 2016 and CY 2017 to account for nominal case-mix growth between CY 2012 and CY 2014 and proposing updates to the Home Health Quality Reporting Program. Finally, CMS is proposing to implement a Home Health Value-Based Purchasing (HHVBP) model effective for CY 2016. CMS estimates that the net impact of this proposed rule would result in a decrease in Medicare payments to HHAs of 1.8 percent ($350 million decrease) for CY 2016.

ATTENTION: There was a misalignment between the case-mix weights and the payment groups in Table 9 of the CY 2016 HH PPS Proposed Rule (CMS-1625-P). The corrected case-mix weights are posted below and a correction notice was published on August 4, 2015.