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CMS Issues 2023 Home Health Proposed Payment Rule

The Centers for Medicare and Medicaid Services (CMS) made available the home health proposed payment rule for Calendar Year (CY) 2023 on June 17th. It will be published in the Federal Register on June 23rd. Significant cuts are proposed. The CMS fact sheet on the rule can be found here.

Overall, there will be a 4.2 percent decrease in Medicare home health payments in 2023. CMS proposes a 7.69 percent reduction in home health payments for 2023 in order to ensure that expenditures under the Patient-Driven Groupings Model (PDGM) meet budget neutrality requirements. PDGM will utilize the same methodology as last year‘s rule.

CMS is asking for comments on how to best apply temporary payment adjustments to account for the $2 billion in excess spending in CY 2020 and 2021 for home health. It does not propose a phase-in of the rate reductions proposed.

Other significant highlights or provisions:

  • Market basket increase of 2.96 percent;
  • Decrease in 30-day payment rate from $2,021.64 to $1,904.76. Agencies that do not submit required quality data will have that rate reduced by 2 percent;
  • Low Utilization Payment Adjustments (LUPAs) are set at the following amounts: skilled nursing – $161.32; physical therapy – $176.32; speech language pathology – $191.66; occupational therapy – $177.54; medical social worker – $258.57; home health aide – $73.04;
  • Modifies some elements of the home health value-based purchasing (VBP) program;
  • Modifies quality reporting measures;
  • Defers the home infusion therapy rate update;
  • Proposes permanent 5 percent cap on negative wage index changes.

The proposed changes are troubling, and members should reach out with their thoughts and comments so that LeadingAge NY can comment on the rule.

Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871