CMS Finalizes Home Health Prospective Payment System

PUBLISHED: Nov 2, 2018
Relevant to: Home Health

The Centers for Medicare & Medicaid Services (CMS) has finalized their final rule for the Home Health Prospective Payment System for 2019 and 2020. In the final rule, CMS made changes to improve access to solutions via remote patient monitoring technology, updated payments for home health care with a new case-mix system, begin the new home infusion therapy benefit, and reduce burden.

Beginning with calendar year (CY) 2020, CMS is implementing changes required by law, including a new case-mix system called the Patient-Driven Groupings Model (PDGM) that puts the focus on patient needs rather than volume of care. The PDGM relies more heavily on patient characteristics to more accurately pay for home health services. Changes in data collection under the new case-mix system, coupled with the changes below regarding meaningful measures and the Home Health Quality Reporting Program, will reduce burden for HHAs by approximately $60 million annually, beginning in CY 2020.

In the final rule, CMS is also allowing the cost of remote patient monitoring to be reported by home health agencies as allowable costs on the Medicare cost report form.

This final rule implements the temporary transitional payments for home infusion therapy services for CYs 2019 and 2020, as required by the Bipartisan Budget Act of 2018, until the new permanent home infusion therapy services benefit begins on January 1, 2021. In addition, the final rule establishes the health and safety standards for qualified home infusion therapy suppliers of the new permanent home infusion therapy service benefit. The final rule also establishes the approval and oversight process for accrediting organizations of these suppliers as required by the 21st Century Cures Act.

CMS is eliminating the requirement that the certifying physician estimate how much longer home health services are needed when recertifying the need for continued home health care. CMS is also removing seven Home Health Quality Reporting Program measures.

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