HHAs: CY 2020 and 2021 New Home Infusion Therapy Benefit and Payment and Policy Changes

On July 11, CMS issued a proposed rule [CMS-1711-P] that proposes routine updates to the home health payment rates for CY 2020, in accordance with existing statutory and regulatory requirements. This rule will also include:

Proposal to modify the payment regulations pertaining to the content of the home health plan of care
Proposal to allow therapist assistants to furnish maintenance therapy
Proposal related to the split percentage payment approach under the Home Health Prospective Payment System (PPS)
Proposals related to the implementation of the permanent home infusion therapy benefit in 2021

This proposed rule sets forth implementation of the Patient-Driven Groupings Model (PDGM), an alternate case-mix adjustment methodology, and a 30-day unit of payment as mandated by the Bipartisan Budget Act of 2018 (BBA of 2018). CMS projects that Medicare payments to Home Health Agencies (HHAs) in CY 2020 will increase in aggregate by 1.3 percent, or $250 million, based on proposed policies. The increase reflects the effects of the 1.5 percent home health payment update percentage ($290 million increase) mandated by BBA of 2018. It also reflects a 0.2 percent decrease in aggregate payments due to reductions made by the new rural add-on policy mandated by the BBA of 2018 for CY 2020 (i.e., an estimated $40 million decrease in rural add-on payments). The rate updates also include adjustments for anticipated changes with implementation of the PDGM and a change to a 30-day unit of payment, the use of updated wage index data for the home health wage index, and updates to the fixed-dollar loss ratio to determine outlier payments.

In addition, the proposed rule includes:

Proposed payment rate changes for home infusion therapy temporary transitional payments for CY 2020
Payment proposals for new home infusion therapy benefit for CY 2021
Regulatory burden reduction – Patients over paperwork and enhance and modernize program integrity
Paraprofessional roles – Improving access to care
Home Health Quality Reporting Program – Support MyHealthEData Initiative
Home Health Value-Based Purchasing model

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