The Final Medicare 2017 HH PPS Rule
The Centers for Medicare and Medicaid Services (CMS) announced late Monday afternoon the final payment changes for the 2017 Home Health Prospective Payment System (HH PPS) rates.
CMS projects the Medicare home health payments will be reduced by 0.7 percent, or $130 million nationwide, instead of the 1 percent (approximate total of $180 million) originally announced in the proposed version of the rule.
Other important highlights of the final rule include:
1. Rebasing the 60-day episode rate
As we have previously reported, the Affordable Care Act (ACA) directs CMS to apply an adjustment to the national standardized 60-day episode rate and other applicable amounts that reflect factors such as changes in the number of visits in an episode, the mix of services in an episode, the level of intensity of services in an episode, the average cost of providing care per episode, and other relevant factors. CMS is implementing the final year of rebasing adjustments as finalized in the Calendar Year (CY) 2014 final rule; for CY 2017, the negative adjustment is $80.95.
2. Updates to Reflect Case-Mix Growth
CMS is decreasing the national standardized 60-day episode payment amount by 0.97 percent in CYs 2016, 2017, and 2018, instead of the original proposed amount of 1.72 percent. The -0.97 percent adjustment to the national, standardized 60-day episode payment rate to account for nominal case-mix growth results in an estimated decrease in HH PPS payments for CY 2017 of 0.9 percent.
3. Outlier Payments
CMS is also changing the methodology used to calculate outlier payments to a per-unit approach.
4. Negative Pressure Wound Therapy (NPWT)
The Consolidated Appropriations Act, 2016 requires a separate payment to be made to HHAs for NPWT using a disposable device when furnished on or after Jan. 1, 2017 to an individual who receives home health services for which payment is made under the Medicare home health benefit.
5. Home Health Value-Based Purchasing (HHVBP) Model
CMS has finalized several changes and improvements related to HHVBP.
6. Home Health Quality Reporting Program (HH QRP) Update
Section 2(a) of the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act) requires the public reporting of data on HHAs, Skilled Nursing Facilities (SNFs), Inpatient Rehabilitation Facilities (IRFs), and Long-Term Care Hospitals' (LTCHs) quality measures, resource use, and other measures. In the final rule, and beginning with the CY 2018 payment determination, CMS adopted four measures to meet the requirements of the IMPACT Act. They are:
- Potentially Preventable 30-Day Post-Discharge Readmission Measure for Post-Acute Care Home Health Quality Reporting Program;
- Total Medicare Spending Per Beneficiary – Post-Acute Care Home Health Quality Reporting Program (MSPB-PAC HH QRP);
- Discharge to Community – Post-Acute Care Home Health Quality Reporting Program; and
- Drug Regimen Review Conducted with Follow-Up for Identified Issues – Post-Acute Care Home Health Quality Reporting Program.
According to the press release, “the HH PPS final rule is one of several rules for calendar year 2017 that reflect a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people. Provisions in these rules are helping to move our health care system to one that values quality over quantity and focuses on reforms such as achieving better health outcomes, preventing disease, helping patients return home, helping manage and improve chronic diseases, and fostering a more efficient and coordinated health care system.”
LeadingAge NY will continue to review the final rule and provide a more detailed analysis.
Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871