CMS Posts the HH PPS Proposed Rule for CY 2014
CMS has released the proposed rule to the Medicare Home Health Prospective Payment System (HH PPS) for Calendar Year (CY) 2014. Important highlights of the proposed rule are:
Reductions in Payments – As outlined in the proposed rule CMS projects that Medicare payments to home health agencies in CY 2014 will be reduced by 1.5 percent, or $290 million based on the proposed policies. The proposed decrease reflects the effects of the 2.4 market basket percent home health payment update ($460 million increase), the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates, and the non-routine medical supplies (NRS) conversion factor ($650 million decrease), and the effects of ICD-9-CM coding adjustments ($100 million decrease).
HH PPS Grouper Refinements from ICD-9 to ICD-10-CM - Two categories of ICD-9-CM codes from the HH PPS Grouper: diagnosis codes that are “too acute,” meaning the condition could not be appropriately cared for in a home health setting; and diagnosis codes for conditions that would not impact the home health plan of care, will be removed in January 2014. ICD-10-CM codes will be included in the HH PPS Grouper to be used starting on Oct. 1, 2014.
Reductions in the 60 day Episodes – In the proposed rule, CMS is announcing a reduction to the national, standardized 60-day episode rate not to exceed 3.5 percent of the amount in any given year from CY 2014 through CY 2017. The proposed national, standardized 60-day episode payment for CY 2014 is $2,860.20.
Quality Reporting- CMS proposes adding two claims-based quality measures: (1) Rehospitalization During the First 30 Days of a Home Health Stay, and (2) Emergency Department Use Without Hospital Readmission during the first 30 days of Home Health. The proposed rehospitalization measures will allow HHAs to further target patients who entered home health after a hospitalization.
Cost Allocations for Home Health Agency Surveys- CMS is seeking to ensure that Medicaid responsibilities for home health surveys are explicitly recognized in the State Medicaid Plan. CMS seeks comment on a methodology for calculating State Medicaid programs’ fair share of Home Health Agency surveys costs. For that portion of costs attributable to Medicare and Medicaid, we would assign 50 percent to Medicare and 50 percent to Medicaid, the same methodology that is used to allocate costs for dually-certified nursing homes.
CMS will accept comments on the proposed rule until Aug. 26, 2013. Please refer to the proposed rule for more details.
LeadingAge NY will continue to analyze the proposed rule and summarize a more detailed analysis.
Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871