CMS Proposes Payment Changes to Medicare Home Health for 2013
The Centers for Medicare & Medicaid Services (CMS) today announced proposed changes to the Medicare home health program for 2013 that would foster greater efficiency, flexibility, payment accuracy and improved quality.
In the proposed rule, on display in the Federal Register today, CMS proposes to reduce Medicare payments to home health agencies in calendar year (CY) 2013 by 0.1 percent, or $20 million. The proposed decrease reflects the combined effects of the home health market basket and wage index updates and previously finalized reductions to the home health prospective payment system (HH PPS) rates to account for changes in coding practices.
The rule proposes to rebase and revise the home health market basket to ensure that it continues to adequately reflect the price changes of providing efficient home health services. The CY 2013 home health market basket would result in a labor-related share of 78.535 percent and a non labor-related share of 21.465 percent.
Provisions of the Affordable Care Act apply a 1 percent reduction to the CY 2013 home health market basket update of 2.5 percent, resulting in a 1.5 percent increase for home health agencies next year. As part of the 2012 HH PPS final rule, CMS finalized a reduction in rates of 1.32 percent in CY 2013 to account for growth in aggregate case-mix that is unrelated to changes in patients’ health status. This is unchanged in this proposed rule. CMS will continue to monitor any future changes in case-mix and make updates as appropriate.
“The proposed rule helps to encourage efficiency and payment accuracy, ensuring continued access to care for Medicare beneficiaries and prudent use of taxpayer dollars,” said Jonathan Blum, deputy CMS administrator and director of the Center for Medicare.
In acute or post-acute care settings, the rule seeks to provide additional flexibility in certifying patients as eligible for the home health benefit. The HH PPS rule proposes other changes to help ensure patients maintain access to therapy services, while reducing burden on home health agencies.
The proposed rule would also promote quality of care for patients by ensuring that home health agencies that are out of compliance with federal health and safety standards, known as the Conditions of Participation, could correct their performance and achieve prompt compliance. The rule would provide agencies with the opportunity to achieve compliance through new methods, such as directed plans of correction or directed in-service training. It would also permit CMS to impose alternative sanctions in addition to termination for agencies that do not maintain or achieve compliance with Federal health and safety standards. The rule would also establish new survey and certification requirements for home health agencies including definitions for types of surveys, survey frequency, surveyor qualifications, and the opportunity for Informal Dispute Resolution. Finally, this rule proposes to extend certain requirements concerning the hospice quality reporting program to subsequent years.
For additional information about the Home Health Prospective Payment System, visit https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/index.html.
The proposed rule can be viewed: http://federalregister.gov/inspection.aspx. Please be mindful this link will change once the proposed rule is published on July 13, 2012 in the Federal Register. CMS will accept comments on the proposed rule until Sep. 04, 2012.