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Proposed Medicare Home Health Prospective Payment System CY 2018

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1672-P) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2018. The proposed rule was published in the Federal Register on Fri., July 28, 2017. CMS issued a press release with highlights of the proposed changes for both CY 2018 and 2019.

Several highlights are listed below:

  • The rule would result in a 0.4 percent decrease (-$80 million) in payments to HHAs in CY 2018. This includes a 1 percent, or $190 million, home health payment update; a 0.97 percent decrease to the national, standardized 60-day episode payment rate to account for nominal case-mix growth for an impact of -0.9 percent, or a $170 million decrease; and the sunset of the rural add-on provision, a $100 million decrease.
  • Proposes case-mix methodology refinements, including a change in the unit of payment from 60-day episodes of care to 30-day periods of care, to be implemented for 30-day periods of care beginning on or after Jan. 1, 2019. CMS is soliciting comments on the phase-out of the split percentage payment approach in the future. The proposed case-mix methodology refinements are called the Home Health Grouping Model (HHGM).
  • In the HH Quality Reporting Program (QRP), CMS is proposing to adopt for the CY 2020 payment determination three measures to meet the requirements of the IMPACT Act and new standardized data elements.
  • Lastly, CMS is also proposing changes to the Home Health Value-Based Purchasing (HHVBP) Model.

LeadingAge NY will be analyzing the proposed rule and providing comments before 5 p.m. on Sept. 25, 2017. Please let me know your concerns. As you know, the final rule is usually posted in the fall with an effective date of Jan. 1st.

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