Proposed Rule on Episodic Pricing for Certified Home Health Agencies (CHHAs)

DOH published a notice of proposed rulemaking that exempts services to a special needs population from the episodic payment system for CHHAs. This change to the episodic payment system was introduced in 2012 and is currently in effect as an emergency rule. The proposed rule does not contain any substantive changes from the prior emergency versions. The amendments will help assure that agencies providing care to special needs populations receive a level of reimbursement that allows them to continue providing access and high quality care.

Some key parts of the proposed rule include:

"[E]ffective for services provided on and after [April 1] May 2, 2012, Medicaid payments for certified home health care agencies (“CHHA”), except for such services provided to children under eighteen years of age and except for services provided to a special needs population of medically complex and fragile children, adolescents and young disabled adults by a CHHA operating under a pilot program approved by the Department, shall be based on payment amounts calculated for 60-day episodes of care."

In addition, the proposed rule provides a case-mix adjustment which reads:

"The base price paid for 60-day episodes of care shall be adjusted by an individual patient case mix index as determined pursuant to subdivision (f) of this section; and also by a regional wage index factor as determined pursuant to subdivision (h) of this section. Such case mix adjustments shall include an adjustment factor for CHHAs providing care primarily to a special needs patient population coming under the jurisdiction of the Office of People With Developmental Disabilities (OPWDD) and consisting of no fewer than two hundred such patients."

Another important component of the proposed rule includes an amendment to section 86-1.44 of title 10 of NYCRR:

"(k) Closures, mergers, acquisitions, consolidations, and restructurings.
The commissioner may grant approval of a temporary adjustment to rates calculated pursuant to this section for eligible certified home health agencies."

The proposed rule continues by describing the process for CHHAs seeking the rate adjustments.

Comments on the proposed rule will be accepted by the DOH until 45 days from 11/15/2013. Please submit your comments to - Katherine Ceroalo, DOH, Bureau of House Counsel, Reg.Affairs Unit, Room 2438, ESP Tower Building, Albany, NY 12237 or email: regsqna@health.state.ny.us.

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