Home Health & Hospice

CMS releases 2015 PPS final rule for home health

Homecare Insider, November 3, 2014

On Thursday, CMS released the 2015 PPS final rule for home health, which holds some good news for providers, particularly on the therapy reassessment and face-to-face fronts.
“Overall, the Final Rule is a slight improvement over the proposed version,” the National Association of Home Care and Hospice stated in its preliminary analysis on the legislation. “The changes to the F2F requirements are most welcome along with the modifications on the therapy assessment requirements.”
As anticipated, the final rule reduces overall reimbursement by $60 million, or 0.30%, a figure that doesn’t account for the 2% sequestration reduction currently in effect through March 2015 for all Medicare providers. In addition, calendar year 2015 will be the second in a four year phase-in for the widely-contested rebasing adjustments to HH PPS payment rates.
The rule also finalizes revisions to the HH PPS wage index based on the newest statistical area delineations released by the Office of Management and Budget (OMB) in a February 2013 bulletin. To ease the adoption of these new rates, CMS seeks to implement a one-year transition period during which a “blended” wage index would be used. This means that 50% of the wage index will come from the current OMB delineations and the other 50% from the 2013 delineations. Based on these updates, CMS will also limit the rural add-on to counties that are considered rural under the new geographic area designations only, meaning that more than 100 counties will lose the add-on as a result.
In addition to reimbursement changes, CMS finalized that physicians no longer need to provide a narrative explaining why a patient is eligible for home health—the most incendiary component of face-to-face documentation. However, providers should note that this provision does not eliminate the need for a patient’s certifying physician to verify that a face-to-face encounter occurred and to document the date of the encounter, which CMS will continue to consider as evidence of a patient’s eligibility for home health services. In addition, CMS clarified that face-to-face encounters are required for certifications, which generally occur whenever a new start-of-care assessment is completed, rather than just initial episodes.
As a result of these updates to certification criteria, CMS also finalized its proposal to deny reimbursement to physicians for a (re-)certification of a patient's home health eligibility if the corresponding HHA claim isn’t covered because the physician’s certification is deemed incomplete, or there is insufficient documentation to support the eligibility.
Despite requests from commenters on July's proposed rule for CMS to halt medical review activities of face-to-face narratives and to reevaluate past denials based on insufficient narratives, the agency says changes finalized within the rule will only become effective for episodes beginning January 1, 2015. CMS also responded to commenters calling for complete elimination of the face-to-face requirement by stating that because the requirement is mandated by the Affordable Care Act, the agency doesn’t have the legal authority to abolish it completely.
Although CMS stuck to many of the provisions outlined in July’s proposed rule, the agency notably strayed from its original plan to introduce a 14-day timeframe for therapy reassessments, granting providers additional leeway in the final rule. Now, CMS will require a qualified therapist from each discipline involved in a patient’s care to conduct a functional reassessment for that individual every 30 calendar days. This new requirement will replace the 13th and 19th visit reassessment provisions, which CMS has nixed through the rule.
“This policy change will lessen the burden on HHAs of counting visits and reduce the risk of non-covered visits so that therapists can focus more on providing quality care for their patients, while still promoting therapist involvement and quality treatment for all beneficiaries regardless of the level of therapy provided,” CMS wrote in an email news release.
Additional changes
As proposed, CMS will revise the home health quality reporting program to establish a minimum threshold for the number of OASIS assessments that each HHA must submit to avoid reductions in annual payment updates. The initial compliance threshold will require agencies to submit admission and discharge assessments for a minimum of 70% of all patients with episodes of care occurring during that reporting period. The threshold will increase in 10% increments over the next two years until a maximum threshold of 90% is reached in CY 2017.
The final rule will also revise the CoPs for speech language pathologist personnel by broadening the criteria for qualification, thus better aligning with the requirements in the Social Security Act by swapping current stringency for a more flexible approach that defers to state licensure requirements.
Finally, inspired by its successful implementation of the Hospital Value-Based Purchasing (VBP) program, CMS may begin testing a VBP model for HHAs beginning in CY 2016 based on comments received on specifications for the model that were outlined in the July proposed rule. The prospective model would include a 5-8% adjustment (increase or decrease) in Medicare payments to HHAs in the five to eight states expected to participate based on their quality of performance, thereby providing “an opportunity to test whether significantly larger incentives would lead to higher quality of care for beneficiaries,” according to the CMS email.
In total, CMS received 337 comments from industry stakeholders.
Click here to read a pre-published version of the complete rule. A final version will be published to this page of the Federal Registrar website on Thursday.