CMS Proposes CY 2019 Home Health Update and CY 2020 Redesign

The Centers for Medicare & Medicaid Services yesterday released the home health prospective payment system proposed rule for calendar year 2019, which also proposes a major redesign for CY 2020. In CY 2019, the rule would increase net HH payments by 2.1% ($400 million) relative to CY 2018. This includes a 2.7% update to current rates, a productivity adjustment of negative 0.7%, a 0.1% increase related to outlier payments, and a 0.1% decrease due to the new rural payment add-on policy mandated by the Bipartisan Budget Act of 2018. In CY 2020, CMS proposes to implement a new case-mix methodology called the patient-driven groupings model, which would eliminate therapy thresholds in determining payment and change the unit of payment to 30-day periods of care. This budget-neutral implementation of the PDGM was also mandated by the BiBA, and follows a prior iteration put forward by CMS last year, which received extensive feedback from the field. “We are concerned that CMS’s proposed reforms to the HH PPS in CY 2020 appear to be similar to the agency’s prior, flawed iteration of a revised PPS, and will closely evaluate the extent to which they include our recommended changes,” said AHA Executive Vice President Tom Nickels. For CY 2019, the rule also proposes to streamline the HH Quality Reporting Program and the HH Value-Based Purchasing Model; to no longer require the certifying physician to estimate how much longer skilled services are needed when recertifying continued services; and to implement transitional payments for home infusion therapy services; as well as other changes. CMS will accept comments on the proposed rule through Aug. 31.