CMS Announces the Implementation of New Policy Changes for Home Health Agencies

The Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 9736, which implements new payment policies to home health agencies (HHAs) effective January 2017.

The CR does the following:

• Outlines payment policies for disposable Negative Pressure Wound Therapy (NPWT) devices. A separate payment for NPWT for patients receiving home health services is set equal to the amount of the payment that would otherwise be made under the Medicare Hospital Outpatient Prospective Payment System (OPPS) using the Healthcare Common Procedure Coding System (HCPCS) code (currently CPT codes 97607 and 97608).
• Implements changes to the methodology used to calculate outlier payments to HHA. As we previously reported, CMS changed the methodology used to calculate outlier payments to a cost-per-unit approach rather than a cost-per-visit approach. In order to ensure that only covered charges are included in the outlier calculation, CMS revised instructions for reporting non-covered charges on home health claims. Effective Jan. 1, 2017, covered and non-covered increments of the same visit must be reported on separate lines.
• Reports four new G-codes associated with registered nurse (RN) and licensed practical nurse (LPN) visits in the home. Effective Jan. 1, 2017, G0163 and G0164 will be retired and instead replaced with four new G-codes:

1. G0493 – Skilled services of a registered nurse (RN) for the observation and assessment of the patient’s condition, each 15 minutes (the change in the patient’s condition requires skilled nursing personnel to identify and evaluate the patient’s need for possible modification of treatment in the home health or hospice setting).
2. G0494 – Skilled services of a licensed practical nurse (LPN) for the observation and assessment of the patient’s condition, each 15 minutes (the change in the patient’s condition requires skilled nursing personnel to identify and evaluate the patient’s need for possible modification of treatment in the home health or hospice setting).
3. G0495 – Skilled services of a registered nurse (RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.
4. G0496 – Skilled services of a licensed practical nurse (LPN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.

CMS believes the new G-codes are needed to more accurately account for the cost of services and resource utilization for the annual recalibration of the case mix weights.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871