Delta Connect Blog

CMS has proposed that the split payments made to home health agencies under the Request for Anticipated Payment (RAP) process will end in 2021.  As an interim step, no new home health care agency will receive RAPs in 2020 and home health agencies that have been in operation since prior to 2019 will receive 20% of the expected final payment amount in contrast to the 60% initial episode/50% later episode levels that have been in place since 2000.

The CY2018 Medicare Home Health payment rule included the Home Health Grouper Model (HHGM), which CMS proposes to implement in 2019 and would be an overhaul of the Medicare payment system. That will provide significant opportunity to address any concerns with the model and to initiate any necessary business adjustments. The model is proposed with 30-day payment periods, the elimination of the therapy visit volume payment determinant in the current model, and an entirely different case mix model focused on patient characteristics.

The Centers for Medicare and Medicaid Service (CMS) released the CY2018 Medicare Home Health payment rule this week. The home health Market Basket Index inflation update for 2018 is preset at 1% along with the suspension of the annual Productivity Adjustment. While the proposal does not reference the 2% sequestration, it is definitely expected that such will continue in 2018.

The Center for Medicare and Medicaid Services (CMS) published the Home Health PPS Final Rule on November 3, 2016. The Final Rule defines many changes in effect January 1, 2017.  These changes include payment rates, HHRG Case Mix Weight recalibration, updates to the Home Health Value-Based Purchasing pilot program, and implements the coverage for Negative Pressure Wound Treatment using disposable systems. 

Despite industry-wide concerns about the prior authorization requirement and how it will affect access to care, CMS has put forward their plans for a three-year Medicare pre-claim review demonstration, now dubbed the Pre-Claim Review Demonstration for Home Health Services.