Federal Updates for Home Health Providers
(Dec. 10, 2024) Please note the following updates from LeadingAge National:
WIN: CMS Updates FAQ on All-Payer OASIS Requirements. In response to many outstanding questions from LeadingAge National in its comment letter on the Calendar Year (CY) 2025 Home Health Proposed Rule, the Centers for Medicare and Medicaid Services (CMS) has updated Outcome and Assessment Information Set (OASIS) E-1 Questions and Answers (Q&As). As of July 1, 2025, all home health agencies will be required to submit OASIS data on all patients regardless of payer source. CMS will allow agencies to start voluntarily submitting all-payer OASIS data on Jan. 1, 2025. In this document, CMS outlines how they intend to use this data, clarification on the requirements for OASIS privacy notice, the patients who are excluded from collection, and how collection will impact Medicaid-only patients and charity patients.
CMS Proposes Changes to Home Health CAHPS Measures. On Nov. 25th, CMS released the 2024 Measures Under Consideration (MUC) List in partnership with Battelle. This list includes all of the quality and efficiency measures CMS will consider adopting, through the federal rulemaking process, in the next CY. Included in the 41 new measures are five measures for the Home Health Quality Reporting Program (HH QRP) – specifically, changes to five Consumer Assessment of Healthcare Providers and Systems (CAHPS) composite measures. Two of the proposed measure changes, Care of Patients and Communications Between Providers and Patient, if adopted could have significant impacts on the Expanded Home Health Value-Based Purchasing (HHVBP) Model. As part of this yearly process, CMS makes the measures publicly available and will seek input through public comments by the CMS Consensus-Based Entity (CBE), Battelle. Comments are due by Dec. 30, 2024. LeadingAge National is honored to have Jodi Eyigor representing the post-acute care and long-term care community as part of the Pre-Rulemaking Measure Review advisory groups.
First IPRs for HHVBP 2025 Performance Year Released. The Preliminary October 2024 Interim Performance Reports (IPRs) for the Expanded HHVBP Model have been published on the Internet Quality Improvement and Evaluation System (iQIES). The quarterly IPRs provide home health agencies with the cohort assignment, performance year measure data for the 12 most recent months, and the interim Total Performance Score (TPS). Using the IPR, agencies can assess and track their performance relative to peers in their respective cohort throughout the Expanded Model performance year. The October 2024 IPRs also report preliminary Achievement Thresholds (AT) and Benchmarks (BM) by volume-based cohort for the quality measure set applicable to the third performance year, CY 2025. As a reminder, the performance measures for the CY 2025 performance year have been updates. An agency will receive an October 2024 IPR if it was Medicare-certified prior to Jan. 1, 2023 and meets the minimum threshold of data for at least one quality measure in the quarterly reporting period for the performance year. To review the new measures as well as the minimum thresholds, click here.
ADVOCACY WIN: Biden CMS MA Rule Addresses Flex Cards and Some Prior Authorization Issues. On Nov. 26th, CMS published its proposed rule for the rules that Medicare Advantage (MA) plans will need to follow in CY 2026, and the 700-plus pages include some clarity that LeadingAge National has been seeking on MA supplemental benefit flexible benefit cards (flex cards), as well as plans' use of internal coverage criteria and artificial intelligence related to prior authorizations and other coverage determinations for traditional Medicare benefits. The flex card clarifications seek to ensure that beneficiaries know what benefits they are eligible for, have assistance and information about accessing the benefits, and that the supplemental benefits are both accessible and adequate to the enrollee’s needs. Regrettably, the rules are silent on whether these flex cards can be counted as income when determining an individual’s eligibility for various government assistance programs. LeadingAge National will be reviewing the details of the proposed rule and providing further analysis in the week ahead, but early indications are that there are some positive regulatory developments. Members should keep in mind that this is a proposed rule and that comments will be due Jan. 27, 2025, which is after the new Trump Administration takes office. For this reason, the new Administration will want to review the proposed rule for alignment with its policy goals and will have the authority to choose not to finalize and implement some or all of the rule. The fact sheet for the proposed rule is available here. The official version of the proposed rule is scheduled to be published in the Federal Register on Dec. 10, 2024, but the draft language can be found here. Read LeadingAge National’s statement on the proposed rule here.
Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871