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From Health Law Daily, November 5, 2015

Home is where the value is, CMS finalizes HH payment update

By Bryant Storm, J.D.

CMS issued a Final rule that updates and revises the Home Health (HH) prospective payment system (PPS) for calendar year (CY) 2016. The Final rule updates the 60-day episode payment rates, the national per-visit rates, the non-routine medical supply (NRS) conversion factor, and implements the rebasing adjustment required by the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). The Final rule implements an HH value-based purchasing (HHVBP) model, which will begin January 1, 2016, for selected HH agencies (HHAs). Minor changes are also made to home health quality reporting program (QRP) (Final rule, 80 FR 68624, November 5, 2015).

Payment updates. The ACA required a four-year phase-in of a rebasing adjustment to the national, standardized 60-day episode payment amount, the national per-visit rates and the NRS conversion factor. For 2016, the third year of the phase-in, the rebasing will “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 with the increases ranging from $1.79 for home health aide services to $6.34 for medical social services, and reduce the NRS conversion factor by 2.82 percent.” The Final rule also updates the HH market basket with an increase of 2.3 percent for CY 2016. After applying a market factor productivity adjustment required by the ACA, the resulting HH payment update percentage is equal to a 1.9 percent increase. For HHAs that do not submit quality data in accordance with the QRP, there will be a 2-percentage point reduction of the payment update.

HHVBP. The Final rule finalizes CMS’ proposal to implement a HHVBP program to begin January 1, 2016. Under that program, Medicare-certified HHAs selected for inclusion in the HHVBP model will compete on quality performance measures for payment adjustments to their current PPS reimbursements. CMS believes the program will reward improved quality and penalize poor performance while incentivizing HHAs to make quality improvement and encourage efficiency. Ultimately, CMS expects the program to lead to a more sustainable payment system. Participants in the program will be eligible to receive an 8 percent increase or decrease to current Medicare payments, “depending on the HHA’s performance on specified quality measures relative to its peers.” The model will test HHAs selected in nine states and will run from 2016 to 2020.

QRP. Additionally, the Final rule makes changes to the QRP for HHAs. The changes include the addition of a new quality measure: a minimum threshold for submission of Outcome and Assessment Information Set (OASIS) assessments for purposes of quality reporting compliance. CMS also set submission dates for the Home Health Care Consumer Assessment of Healthcare Providers and Systems Survey (HHCAHPS) Survey through CY 2018.

MainStory: TopStory FinalRules HomeNews CMSNews HealthReformNews PaymentNews ProgramIntegrityNews QualityNews PartANews

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