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From Health Law Daily, July 10, 2015

CMS proposes value based model for 2016 Home Health PPS

By Bryant Storm, J.D.

CMS issued a Proposed rule to update and revise the Home Health (HH) prospective payment system (PPS) for calendar year (CY) 2016. Through an update of the HH PPS 60-day episode payment rate, the national per-visit rate, and the non-routine medical supply (NRS) conversion factor for home health agencies (HHAs), the Proposed rule represents the third year in a four-year rebasing of the HHS PPS rates as required by the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). The Proposed rule also makes changes to the HH quality improvement program and proposes an HH value-based purchasing (HHVBP) model which would begin January 1, 2016 (Proposed rule, 80 FR 39840, July 10, 2015).

Adjustments. Under Section 3131(a) of the ACA, CMS is obligated to make phased-in adjustments to the HH PPS over a four-year period. In the third year of rebasing, under the CMS proposal, the rebasing adjustments for CY 2016 would reduce the national, standardized 60-day episode payment amount by $80.95, increase the national per-visit payment amounts by 3.5 percent of the national per-visit payment amounts in CY 2010, and reduce the NRS conversion factor by 2.82 percent. The rule also proposes efforts to continue monitoring the effects of the rebasing adjustments.

Quality. The Proposed rule includes proposals for changes to the HH quality improvement program. Specifically, CMS is proposing the addition of one new quality measure, the creation of a minimum threshold for the reporting of Outcome and Assessment Information Set (OASIS) assessments, and the establishment of submission dates for Home Health Care Consumer Assessment of Healthcare Providers and Systems Survey (HHCAHPS) Survey which will run through CY 2018.

HHVBP. According to CMS, Medicare-certified HHAs in nine states have been randomly selected to participate in a proposed HHVBP model, which would award HHAs with payment adjustment incentives to their current PPS reimbursements based upon the quality of their performance. The HHVBP model was initially proposed in the 2015 HH PPS Final rule (79 FR 66032, November 6, 2014). After receiving no strong counterpoints or alternative design options in the comments to that Final rule, CMS is proposing to move forward with the HHVBP model. The payment model is designed to improve beneficiaries’ experience and outcomes by both rewarding improved quality and penalizing poor performance.

Through the use of an innovation waiver acquired under Section 1115(A) of the Social Security Act, the proposed program would provide a reduction or increase in HH PPS reimbursement of up to 8 percent. The proposed model would run from 2016 to 2020. The proposal sets out three goals for the HHVBP model: (1) to incentivize HHAs to provide higher quality and more efficient care; (2) to study new potential quality and efficiency measures; and (3) enhance current public reporting processes.

CMS will accept comments on the Proposed rule until September 4, 2015.

MainStory: TopStory ReimbursementNews CMSNews HomeNews HealthReformNews MedicaidPaymentNews PaymentNews QualityNews

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