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CMS Issues Proposed 2021 Payment Rule for Home Health

On June 25th, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule for Calendar Year (CY) 2021 that updates the Medicare payment rates for home health agencies (HHAs). This proposed rule also includes a provision to make permanent the regulatory changes related to telecommunications technologies in providing care under the Medicare home health benefit beyond the expiration of the Public Health Emergency (PHE) for the COVID-19 pandemic.

According to CMS, the 2021 proposed Medicare home health rates represent a modest market-basket update, a significant change in wage index area designations, no change in the structure of the Patient-Driven Groupings Model (PDGM), a scheduled phasing-out of the rural add-on, and a continuation of outlier payment standards.

The rule allows HHAs to continue to utilize telecommunications technologies in providing care to beneficiaries under the Medicare home health benefit beyond the COVID-19 PHE, as long as the telecommunications technology is related to the skilled services being furnished, is outlined on the plan of care, and is tied to a specific goal indicating how such use would facilitate treatment outcomes. The rule would still not count telehealth as an in-person visit.

CMS states that the rule proposes routine, statutorily-required updates to the home health payment rates for CY 2021. It estimates that Medicare payments to HHAs in CY 2021 would increase in the aggregate by 2.6 percent, or $540 million, based on the proposed policies. This increase reflects the effects of the proposed 2.7 percent home health payment update percentage ($560 million increase) and a 0.1 percent decrease in payments due to reductions made in the rural add-on percentages mandated by the Bipartisan Budget Act of 2018 for CY 2021 ($20 million decrease). This rule also proposes to update the home health wage index, including the adoption of revised Office of Management and Budget (OMB) statistical area delineations and limiting any decreases in a geographic area’s wage index value to no more than 5 percent in CY 2021.

For more information:

Comments on the proposed rule are due by Aug. 28th. LeadingAge NY will be analyzing the rule and encourages members to provide comments and concerns to our office so that we can submit public comment to CMS.

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