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United States: CMS Proposes New Home Health Agency Rule Including Potential Changes To Reimbursement, Coverage, Quality, And More: CMS Accepting Comments Until September 9, 2019
On July 11, 2019, the Centers for Medicare and Medicaid Services
("CMS") announced a proposed rule for home health
agency Medicare reimbursement that would increase payments by an
aggregate 1.3% for 2020, amounting to $250 million. In doing so,
CMS would begin a transition to payments that are value-based,
implementing the Patient-Driven Groupings Model ("PDGM"),
an alternate case-mix payment methodology. In the PDGM, home health
agencies are paid for 30 rather than 60-day episodes of care, and
reimbursement is based on patient characteristics rather than the
number of therapy visits provided. In a statement from CMS
administrator Seema Verma regarding the proposed rule, she said the
PDGM will reward "value over volume." The proposed
changes to reimbursement also include a one-year phasing out of
pre-payments for home health services, known as Requests for
Anticipated Payment. These proposed changes reflect a significant
shift in the manner in which home health agencies historically have
been reimbursed.
The rule, if finalized, would also create a permanent home
infusion therapy benefit in 2021, allowing beneficiaries to receive
critical infusion drug therapies in their homes through the use of
durable medical equipment. In her statement, Verma said the benefit
"will give patients the freedom to safely access critical
treatments, such as chemotherapy, at home instead of traveling to
the hospital or doctor's office, improving their quality of
life." CMS proposes grouping home infusion drugs into three
payment categories, each with a single unit of payment in
accordance with specified infusion codes and units, to allow
providers and suppliers sufficient time to prepare for the
implementation of the benefit.
Other proposed changes include adding two quality measures that
assess the transfer of health information to the Home Health
Quality Reporting Program ("HH QRP"), adopting
standardized patient assessment data elements ("SPADEs"),
removing the Improvement in Pain Interfering with Activity Measure
from the HH QRP, publicly reporting Home Health Value-Based
Purchasing Model performance data, and allowing therapist
assistants to furnish maintenance therapy to patients in their
homes under the Medicare home health benefit.
CMS will accept comments on the proposed rule through September
9, 2019.
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