CMS Posts Home Health Proposed Payment Update Rule

CMS posted the proposed home health payment update rule on the Federal Register Public Inspection desk on June 17, 2022. The rule will be posted in the Federal Register on June 23. 2022.

Medicare Program 2023 Home Health Prospective Payment System

Summary of the rule:

  • The proposed rule includes proposals and routine updates to the Medicare Home Health PPS and the home infusion therapy services’ payment rates for CY 2023, in accordance with existing statutory and regulatory requirements.
    • CMS estimates that Medicare payments to HHAs in CY 2023 would decrease in the aggregate by -4.2%, or -$810 million compared to CY 2022, based on the proposed policies.
  • In addition, CMS is proposing to apply a permanent prospective payment adjustment to the home health 30-day period payment rate to account for any increases or decreases in aggregate expenditures, because of the difference between assumed behavior changes and actual behavior changes, due to the implementation of the Patient-Driven Groupings Model (PDGM) and 30-day unit of payment.
  • CMS is soliciting comments on how best to implement a temporary payment adjustment for CYs 2020 and 2021.
  • CMS is also soliciting comments on the collection of telehealth data on home health claims to allow them to analyze the characteristics of the beneficiaries’ utilizing services furnished remotely.
  • They propose to end the suspension of non-Medicare / non-Medicaid data for HHA patients. HHAs would be required to submit all-payer OASIS data for purposes of the HH Quality Reporting Program (QRP), beginning with the CY 2025 program year.
  • For the Expanded HHVBP Model, CMS is proposing to:
    • Add definitions for HHA baseline year and Model baseline year, and remove the previous definition of baseline year;
    • Change the HHA baseline year from CY 2019 to CY 2022 for existing HHAs with a Medicare certification date prior to January 1, 2019, and from 2021 to 2022 for HHAs with a Medicare certification date prior to January 1, 2022 starting in the CY 2023 performance year; and,
    • Change the Model baseline year from CY 2019 to CY 2022 starting in CY 2023.
    • CMS They are soliciting public comments on publicly reporting a composite structural health equity quality measure; displaying descriptive information on Care Compare from the data HHAs provide to support health equity measures; and the impact of determined domains and quality measure concepts on organizational culture change.
  • CMS is seeking stakeholder feedback on our work around health equity measure development for the Home Health QRP and the potential future application of health equity in the Expanded HHVBP Model’s scoring and payment methodologies.

CMS Fact Sheet – CY 2023 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Requirements Proposed Rule (CMS-1766-P)

Comments for this proposed rule must be received no later than 5 p.m. on August 16, 2022. Addresses and methods for submitting comments are included in the proposed rule.