CY 2023 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Home Infusion Therapy Requirements
CMS issued a proposed rule [CMS-1766-P] that proposes routine updates to the home health payment rates for calendar year (CY) 2023, in accordance with existing statutory and regulatory requirements. This proposed rule discusses home health utilization; proposes 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; proposes a permanent prospective adjustment to the CY 2023 home health payment rates and solicits comments on the best approach to implement the temporary retrospective adjustment. This rule also proposes the reassignment of certain diagnosis codes under the PDGM; and proposes to establish 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. This rule also proposes 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. Additionally, this rule discusses the future collection of data regarding the use of telecommunications technology during a 30-day home health period of care on home health claims.
CY 2023 Proposed HH PPS Wage Index (ZIP)
CY 2023 Proposed PDGM Case Mix Weights and LUPA Thresholds (ZIP)
CY 2023 Proposed HH Clinical Group and Comorbidity Adjustment Diagnosis List (ZIP)
CY 2023 Proposed Reassignment of ICD-10 CM Diagnosis Codes for HH PDGM Clinical Groups and Comorbidity Subgroups (ZIP)