The Centers for Medicare & Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service (FFS) home health (HH) prospective payment system (PPS) for calendar year 2019.
Unless otherwise noted, provisions of the final rule take effect Jan. 1, 2019. Highlights of the final rule include:
- Providing a net 3.77 percent update to the HH payment rates after budget-neutrality and other adjustments. The rule results in increasing the HH conversion factor from $3,039.64 to $3,154.27 for agencies that comply with the quality program reporting requirements.
- Redesigning the HH PPS in 2020, as mandated by the Bipartisan Budget Act of 2018, by replacing the existing therapy-based payment system with a new model known as the patient-driven groupings model. Overall, this model will be budget-neutral, but it is expected to increase payments for facility-based HH agencies by nearly 4 percent.
- Establishing 30-day periods of care in 2020 rather than the current 60-day periods.
- Implementing temporary transitional payments for home infusion therapy services for 2019 and 2020, as required by the Bipartisan Budget Act of 2018, until the new permanent home infusion therapy services benefit begins Jan. 1, 2021.
- Allowing the cost of remote patient monitoring to be included as allowable costs by HH agencies on the Medicare cost report
- Removing seven quality measures from the HH Quality Reporting Program.
- Implementing an approval and oversight process for accrediting organizations of home infusion therapy suppliers as required by the 21st Century Cures Act.
- Eliminating the requirement that the certifying physician estimate how much longer home health services are needed when recertifying the need for continued home health care, which should reduce the burden for physicians and allow them to spend more time with patients.
The American Hospital Association issued a special bulletin regarding the final rule.