Medicare Home Health Agencies Face Upcoming Payment Changes
CMS estimates a $260 million reduction in home health agency Medicare payments.
By - The Medicare home health prospective payment system (HH PPS) can expect payment changes next year, confirms an announcement from the Centers for Medicare & Medicaid Services (CMS). These payment changes aim to ensure greater payment accuracy, care quality advancements, and increased levels of efficiency, CMS says.
“Provisions in these rules will help move the nation’s health-care system to one that values quality over quantity and focuses on reforms such as measuring for better health outcomes, helping patients return home, managing and improving chronic diseases, and fostering a more-efficient and coordinated health care system,” CMS states.
According to a CMS fact sheet, under various mandates of the Affordable Care Act (ACA), CMS must apply an adjustment to the national, standardized 60-day episode payment with consideration of numerous components.
Such facets include changes in visit number for an episode, an episode’s services combination, services’ intensity levels, and an episode’s average cost to deliver care, says CMS.
CMS's adjustment must be implemented in equal increments over the course of four years, writes CMS's fact sheet. Such is not to exceed 3.5 percent of the amount(s) as of the Affordable Care Act's enactment date five years ago and is to be implemented in full within two years.
Last year, nearly 3.5 million beneficiaries received home health services among nearly 12,000 home health agencies (HHAs) at a sizable cost of nearly $18 billion.
Home health services – which include skilled nursing, home health aide, physical therapy, occupational therapy, speech-language pathology, and medical social services – provide beneficiaries with the option to receive care from the comfort of their own home.
According to estimates from CMS, next year will bring a $260 million – 1.4 percent – reduction in HHA Medicare payments stemming from a nearly 2 percent home health payment update percentage of $345 million.
As RevCycleIntelligence.com reported, CMS published a star ratings system earlier this year to help healthcare consumers make better informed decisions about their healthcare options regarding home health care choice.
CMS says it is in the process of completing an innovative initiative – the Home Health Value-Based Purchasing (HHVBP) model – to promote quality care among Medicare-certified HHAs.
Explains CMS, “Authorized under the ACA and implemented by the Center for Medicare and Medicaid Innovation, the HHVBP model supports the Department of Health and Human Services’ efforts to build a health care system that delivers better care, spends health care dollars more wisely, and results in healthier people and communities."
Implementation of the HHVBP model will begin next January among HHAs across nine states, each representative of a nationwide geographic region. Payments regarding such will be adjusted in coming years, CMS maintains.
“All Medicare-certified HHAs that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee will compete on value in the HHVBP model, where payment is tied to quality performance,” says CMS, additionally confirming the following:
[These HHAs] will have their payments adjusted by a maximum payment adjustment of 3-percent (upward or downward) in 2018, a maximum payment adjustment of 5-percent (upward or downward) in 2019, a maximum payment adjustment of 6-percent (upward or downward) in 2020, a maximum payment adjustment of 7-percent (upward or downward) in 2021, and a maximum payment adjustment of 8-percent (upward or downward) in 2022.
