CMS Finalizes Medicare Home Health Payment Rule
(Nov. 5, 2024) The Centers for Medicare and Medicaid Services (CMS) issued the final 2025 Medicare Home Health Prospective Payment Rule on Fri., Nov. 1st. The final rule published in the Federal Register can be found here, the Fact Sheet for the rule is here, and LeadingAge National's reaction to the rule is here.
CMS estimates that Medicare payments to home health agencies (HHAs) in calendar year (CY) 2025 will increase in the aggregate by 0.5 percent, or $85 million, compared to CY 2024. This is an improvement from the aggregate decrease of -$280 million proposed in June.
This rule finalizes a permanent prospective adjustment of -1.975 percent (half of the calculated permanent adjustment of -3.95 percent) to the CY 2025 home health payment rate to account for the impact of implementing the Patient-Driven Groupings Model (PDGM). This adjustment, which is required by the Bipartisan Budget Act of 2018, accounts for differences between assumed behavior changes and actual behavior changes on estimated aggregate expenditures due to the CY 2020 implementation of PDGM and the change to a 30-day unit of payment. For CY 2023 and CY 2024, CMS previously applied a 3.925 percent reduction and a 2.890 percent reduction. Along with the 4.36 percent permanent prospective reduction made in 2020, these permanent adjustments total around a 13 percent decrease since the transition to PDGM.
The final rule also includes four new reporting items under the Home Health Quality Reporting Program relating to living situations, food (two), and utilities.
Among other changes, the rule also amends the Conditions of Participation to include a new standard at § 484.105(d) for an admission to service policy that requires certified home health agencies (CHHAs) to develop, implement, and maintain an acceptance to service policy that is applied consistently to each prospective patient referred for home health care. The policy must address, at minimum, the following criteria related to the CHHA’s capacity to provide patient care: the anticipated needs of the referred prospective patient, the CHHA’s case load and case mix, the CHHA’s staffing levels, and the skills and competencies of the CHHA staff. CMS is also finalizing its proposal that CHHAs would be required to make public, such as on the website, the services provided and any limitations on the duration and frequency of services.
LeadingAge NY will be reviewing the final rule and expects that LeadingAge National will be providing a detailed article.
Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871