CMS Moves Forward on Changes to Home Health Prospective Payment System
Today, the Centers for Medicare & Medicaid Services (CMS) proposed significant changes to the Home Health Prospective Payment System which, according to CMS, will strengthen and modernize Medicare, drive value, and focus on individual patient needs rather than volume of care. Specifically, CMS is proposing changes to improve access to solutions via remote patient monitoring technology, and to update the payment model for home health care.
CMS’s proposed changes would allow the cost of remote patient monitoring to be reported by home health agencies as allowable costs on the Medicare cost report form. This is expected to help foster the adoption of emerging technologies by home health agencies and result in more effective care planning, as data is shared among patients, their caregivers, and their providers. Supporting patients in sharing this data will advance the Administration’s MyHealthEData initiative.
As required by the Bipartisan Budget Act of 2018, this proposed rule would also implement a new Patient-Driven Groupings Model (PDGM) for home health payments. The current system pays for 60-day episodes of care and relies on the number of therapy visits a patient receives to determine payment. The PDGM would eliminate the use of “therapy thresholds” in determining payment and changes the unit of payment to 30-day periods of care. The improved structure would move Medicare towards a more value-based payment system that puts the unique care needs of the patient first while also reducing the administrative burden associated with the HH PPS. The PDGM model, an updated version of the widely opposed Home Health Groupings Model, would be implemented in a budget-neutral manner on January 1, 2020. The proposed changes are projected to increase Medicare payments to home health agencies by 2.1%, or $400 million, in calendar year 2019, according to CMS.
LeadingAge New York will be analyzing this extensive proposal and will report on its potential impacts. For more information on the changes, including the proposed rule, its fact sheet, press release and related CMS initiatives, please click here.
Contact: Meg Everett, meverett@leadingageny.org, 518 867-8871