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Medicare Home Health PPS for 2017 Now Posted

The Centers for Medicare and Medicaid Services (CMS) posted the proposed payment changes for the Medicare Home Health (HH) Prospective Payment System (PPS) for calendar year (CY) 2017 in the July 5, Federal Register.

Important highlights of the proposed rule are:

  • Reducing home health payments by one percent in calendar year (CY) 2017, or $180 million.
  • Rebasing the 60-day episode rate

As we have previously reported, the Affordable Care Act (ACA) directs CMS to apply an adjustment to the national, standardized 60-day episode rate that reflect factors such as changes in the number of visits in an episode, the mix of services in an episode, the level of intensity of services in an episode, the average cost of providing care per episode, and other relevant factors. In the proposed rule, CMS continues to implement the fourth and final year of rebasing adjustments to the HH PPS. As finalized in the Calendar Year (CY) 2014 final rule, for CY 2017 CMS continues the base episodic rate reduction of $80.95.

Outlier Payments

CMS is proposing to make changes to the methodology used to calculate outlier payments.

Negative Pressure Wound Therapy 

CMS is proposing to make changes to the payment for negative pressure wound therapy (NPWT) performed using a disposable device for patients being served by home health agencies (HHAs).

IMPACT Act

The Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act)  requires HHAs to submit standardized patient assessment data, as well as standardized data on quality measures and resource use, and other measures. The IMPACT Act requires collection across eight domains. In the proposed rule, CMS is adopting four new payment determination measures for 2018 to meet the IMPACT Act requirements. The measures are preventable hospital readmission rates, total estimated Medicare spending per patient, discharge to the community and medication reconciliation.

Home Health Value-Based Purchasing (HHVBP) Model

We have reported that CMS started a new initiative designed to support greater quality and efficiency of care among Medicare-certified HHAs across the nation. According to a former press release, “the HHVBP model leverages the successes of and lessons learned from other value-based purchasing programs and demonstrations – including the Hospital Value-Based Purchasing Program and the Home Health Pay-for-Performance and Nursing Home Value-Based Purchasing Demonstrations – to shift from volume-based payments to a model that promotes the delivery of higher quality care to Medicare beneficiaries.” CMS started the HHVBP model among all HHAs in nine states representing each geographic area in the nation so that there is a fair and equal sample of all Medicare-certified HHAs delivering services within those states. CMS is now proposing several changes and improvements to HHVBP.

LeadingAge NY will continue to review the proposed rule and provide a more detailed analysis in the future.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871