On July 1, CMS issued a proposed rule to update Medicare's Home Health PPS payment rates and wage index for calendar year 2015. Payments to home health agencies are estimated to decrease by approximately 0.30% or -$58 million in 2015.The calculations don't include the 2% sequestration reduction currently in effect through March 2015 for all Medicare providers.
This proposed rule also proposes changes to:
- Simplify the face-to-face encounter regulatory requirements by:
- Eliminating the requirement that certifying physicians provide a narrative in their own words explaining why the patient is eligible for home health care. The certifying physician would still be required to certify that a face-to-face patient encounter occurred and to document the date of the encounter.
- Limiting medical reviews to medical records from the patient's certifying physician or from the discharging facility when determining initial eligibility for the home health benefit.
- Disallowing certification and re-certification claims by physicians when the agency claim is denied on grounds that the patient was ineligible for home health.
- Clarifying the face-to-face encounter requirement applies to physician's certification only, not the re-certification of eligibility for subsequent episodes.
- Recalibrating case-mix weights using the most current cost and utilization data.
- Revise the home health quality reporting program requirements
- Establish a minimum submission threshold for the number of OASIS assessments that each agency must submit. The initial compliance threshold would be 70% and will increase by 10% increments over the next two years to reach a maximum threshold of 90%.
- Simplify the therapy reassessment timeframes by having the reassessments occur every 14 calendar days rather than before the 14th and 20th visits and once every 30 calendar days.
- Revise the Home Health Conditions of Participation (CoPs) for speech language pathologist personnel by replacing current stringent requirements with a more flexible option that defers to state-licensure requirements.
- Limit the reviewability of the civil monetary penalty provisions.
