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CMS Finalizes 2021 Home Health Payment Rule

The Centers for Medicare and Medicaid Services (CMS) issued a final rule last week that finalizes updates to the home health payment rates for calendar year (CY) 2021. CMS estimates that Medicare payments to home health agencies (HHAs) in CY 2021 will increase in the aggregate by 1.9 percent, or $390 million, based on the finalized policies. The rule also makes permanent certain blanket regulatory waivers to the home health Conditions of Participation that were issued during the Public Health Emergency. Significantly, it pushes off the expansion of the Home Health Value-Based Purchasing (HHVBP) program to 2023 and provides for its preparation. The rule can be found here.

The rule does not address reimbursement for home health telehealth services to be made on par with in-person visits. However, it does expand the definition of telecommunications technology, in addition to remote patient monitoring, that HHAs are allowed to report as allowable administrative costs on the HHA cost report.

Other changes include the following:

  • CMS will move forward with the expansion of the HHVBP demonstration nationwide in 2023. CY 2022 will be a pre-implementation year to allow agencies to prepare for HHVBP.
  • A market-basket increase of 2.6 percent based on an annual inflation update of 3.1 percent, reduced by a 0.5 percent productivity adjustment.
  • Updated tables for the CY 2022 standardized 30-day Patient-Driven Groupings Model (PDGM) unit payment and updated CY 2022 per-visit rates used in Low Utilization Payment Adjustments (LUPAs).
  • A new LUPA add-on payment for Occupational Therapists, who can now conduct the initial and comprehensive home health assessments when certain conditions are met.
  • The continuation of the phase-out of the Request for Anticipated Payment (RAP) process with the implementation of a Notice of Admission (NOA) process beginning in CY 2022.

LeadingAge NY will be reviewing the rule for further analysis. Please feel free to contact our office with questions or concerns.

Contact: Meg Everett, meverett@leadingageny.org, 518-929-9342