Home Health Prospective Payment System final rule for 2013 posted

CMS issued a final rule on Friday, “Medicare Program; Home Health Prospective Payment System (HHPPS) Rate Update for Calendar Year (CY) 2013, Hospice Quality Reporting Requirements, and Survey and Enforcement Requirements for Home Health Agencies.” The final rule will be published in the Federal Register on Nov. 8, 2012. We will be analyzing the final rule in depth but wanted to provide an initial overview.  The final rule:

- Revises the home health market basket; reflects an updated wage index ($70 million decrease); the 1.3 percent home health payment update ($260 million increase); a new fixed dollar loss ratio of 0.45 ($50 million increase), and a 1.32 percent case-mix adjustment applicable to the national standardized 60-day episode estimated to remain virtually unchanged (decreasing by approximately 0.01 percent or an estimated $10 million decrease in payments to HHAs);

- Allows additional regulatory flexibility regarding therapy reassessments and face-to-face encounter requirements (see page 113-131);

- Extends certain hospice quality reporting requirements to subsequent years (see page 160); and,

- Establishes new survey and certification requirements for HHAs and provides a number of alternative (or intermediate) sanctions if HHAs were out of compliance with Medicare Conditions of Participation (see page 171). The Civil Money Penalties are reviewed on page 220 – 233.

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