Home Health & Hospice

CMS Releases 2013 Home Health Proposed Rule

Homecare Insider, July 16, 2012

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule Friday, July 6, which will make changes to Medicare home health payments for 2013.

The proposed rule indicates a 0.10 percent decrease to the standardized 60-day episode rate. This payment decrease reflects the combined effects of the home health market basket update and wage index updates and reductions to the HH Prospective Payment System to account for a 1.32 percent case-mix coding adjustment.

According to the official CMS press release, provisions of the Affordable Care Act apply a 1 percent reduction to the 2013 home health market basket update of 2.5 percent, resulting in a 1.5 percent increase for home health agencies next year.  As part of the 2012 final rule, CMS finalized a reduction in rates of 1.32 percent in 2013 to account for growth in aggregate case-mix that is unrelated to changes in patients’ health status. There were no changes made to this in the 2013 rule.

According to the CMS website, along with the payment changes, the proposed rule also proposes to:

1. Rebase and revise the home health market basket

The 2013 home health market basket would result in a labor-related share of 78.535 percent and a non labor-related share of 21.465 percent.

2. Allow additional regulatory flexibility regarding therapy documentation and reassessments as well as face-to-face encounter requirements

Currently, when an agency misses a therapy reevaluation in a multidisciplinary case, all disciplines could not be billed, until the qualifying therapist completed a reevaluation, says J’non Griffin, RN MHA, WCC, HCS-D, COS-C, owner of Home Health Solutions, LLC, a home health and hospice consulting service. Griffin explains that the proposed rule states that only the discipline, who failed to perform the required reassessment, was the discipline that could not bill until the appropriate reevaluation happened. The other disciplines who have met the requirement, can continue to bill for these visits.

“Overall, though, this will still impact decreased reimbursement because of having uncollectable visits performed. The proposed rule also clarifies that in a multi-discipline therapy case, the therapists could perform the required assessment at the 11, 12 or 13 visit and the 17, 18 or 19 visit,” says Griffin.

3. Establish new survey and certification requirements for home health agencies including definitions for types of surveys, survey frequency, surveyor qualifications, and the opportunity for Informal Dispute Resolution. 

4. Extend certain requirements concerning the hospice quality reporting program to subsequent years.

This proposed rule also concerns hospice providers as the rule proposes new requirements concerning the hospice quality reporting program.

5. Ensure that home health agencies that are out of compliance with the Conditions of Participation, could correct their performance and achieve prompt compliance.

The proposed rule would provide agencies with the opportunity to achieve compliance through new methods, such as directed plans of correction or directed in-service training.  It would also permit CMS to impose alternative sanctions in addition to termination for agencies that do not maintain or achieve compliance with Federal health and safety standards.

“Perhaps, potential impact that may be overlooked are the sanctions for agencies, not only for immediate jeopardy, but also for agencies under conditional deficiencies,” says Griffin. “These may include CMS mandated management of the agency, who is allowed to make personnel changes and do what is needed to assist the agency back to substantial compliance. In addition, monetary sanctions, suspension of payments, and suspension of new PPS admissions may be implemented.”

CMS will accept comments on the proposed rule until September 4.

Beacon Health will continue to provide in-depth analysis of the proposed rule over the coming weeks.