Home Health & Hospice

CMS Releases Home Health PPS 2011 Final Rule

Homecare Insider, November 8, 2010

The final rule that the homecare community has been waiting for is here. On November 2, the Centers for Medicare and Medicaid Services (CMS) issued the Home Health Prospective Payment System (HH PPS) 2011 Final Rule. The final rule differs in many ways from the original proposed rule. Here are some important differences:

  • CMS has deferred the removal of the hypertension codes (401.9, 401.1).
  • CMS has deferred the 2012 payment reduction pending further study.
  • Therapy assessment and coverage and documentation standards have been revised to allow more flexibility and clarification. The effective date is now April 1, 2011, which allows providers more time to transition since such important changes have been made to this rule.
  • CMS is considering delay of the additional G-code implementation and adopting separate codes for observation and assessment and management and evaluation of care plan.
  • CMS is extending the deadline for agencies to apply for the HHCAHPS exemption for 2010 until January 21, 2011.
  • CMS is deferring the application of the 3.79 percent case mix reduction to the non-routine supplies payment amounts pending further review.
  • Several revisions and clarifications were made to the 36-month rule containing significant exceptions.
  • Home health and hospice face-to-face physician encounter regulations have been revised to allow more flexibility and rule language has been clarified. Significant changes have been made to these requirements.
  • CMS decreased the market basket index increase to 2.1 percent, which is down from the proposed 2.4 percent.

CMS promises to review its method of assessing case mix weight changes before making further adjustments. You can download the final rule at http://www.ofr.gov/OFRUpload/OFRData/2010-27778_PI.pdf. The Federal Register containing the final rule will be published on or around November 17th.