On November 2, 2021, CMS put on display its final rule that, among other things, updates the home health and home infusion therapy services payment rates for calendar year (CY) 2022; makes significant changes to the provider and supplier enrollment processes and survey and enforcement requirements of hospice programs; finalizes modifications to the effective date for reporting of measures and certain standardized patient assessment data in the Inpatient Rehabilitation Facility (IRF) Quality Reporting program; and makes permanent selected regulatory blanket waivers related to home health aide supervision that were issued to Medicare participating home health agencies during the COVID-19 public health emergency.
Home Health Prospective Payment System (HH PPS)
The final rule provides a summary of comments on Patient-Driven Grouping Model (PDGM) monitoring data and analyses on home health utilization, low utilization payment adjustments (LUPA), and the distribution of the case-mix methodology as determined by clinical groupings, admission sources, and timing, functional status, and comorbidities. The final rule also finalizes the recalibration of the PDGM case-mix weights, functional levels, and comorbidity adjustment subgroups while maintaining the CY 2021 LUPA thresholds for CY 2022. Further, the final rule contains updates to the home health wage index, the national, standardized 30-day period payment rates, and the national per-visit payment amounts by the home health payment update percentage.
Home Health Value Based Purchasing (HHVBP) Model
The final rule finalized CMS’s proposal to expand the HHVBP model to all Medicare-Certified home health agencies across the United States and its territories. However, due to the expansion, and in response to comments, CMS is designating CY 2022 as a pre-implementation year, with CY 2023 as the first performance year and CY 2025 as the first payment year. There will be a maximum payment adjustment of 5 percent, upward or downward. All home health agencies certified to participate in the Medicare program prior to 2022 must participate and would be eligible to receive an annual total performance score based on their CY 2023 performance. The original HHVBP model will end one year early.
Home Health (HH) Quality Reporting Program (QRP)
CMS is finalizing the updates to the HH QRP, to include the removal of one OASIS-based measure, replacement of two claims-based measures with one claims-based quality measure; public reporting of two measures; and revising the compliance date for certain reporting requirements for certain HH QRP reporting requirements.
Changes to the Home Health Conditions of Participation
In the Final Rule, CMS makes permanent selected regulator blanket waivers related to home health aide supervision that CMS extended to Medicare-participating home health agencies during the COVID-19 public health emergency. Additionally, CMS will now permit an occupational therapist to conduct a home health initial assessment visit and complete a comprehensive assessment under the Medicare program when occupational therapy is on the home health plan of care, with either physical therapy or speech therapy and when skilled nursing services are not initially in the plan of care.
Medicare Coverage of Home Infusion Therapy
The final rule contains significant adjustments to the home infusion therapy services payment adjustments, to include updates to the geographic adjustment factors.
Provider and Supplier Enrollment Processes
In addition to the foregoing, CMS, through the final rule, also addresses policies related to: (1) the effective date of billing privileges for certain provider and supplier types and the effective date of certain provider enrollment transactions; and (2) the deactivation of a provider’s or supplier’s billing privileges.
Survey and Enforcement Requirements of Hospice Programs
The final rule enhances the hospice survey process by requiring the use of multidisciplinary survey teams, prohibiting surveyor conflicts of interest, expanding CMS-based surveyor training to accrediting organizations (AOs), and requiring AOs with CMS-approved hospice programs to begin use of the Form CMS-2567; establishing a hospice program complaint hotline, and creating the authority for imposing enforcement remedies for noncompliance hospice programs including the development and implementation of a range of remedies.
Inpatient Rehabilitation Facility (IRF) and Long-Term Care Hospital (LTCH) Quality Reporting Programs
CMS finalized its proposals to modify the compliance date for certain reporting requirements in the IRF and LTCH QRPs.
COVID-19 Reporting Requirements for Long-Term Care (LTC) Facilities
CMS finalized COVID-19 reporting requirements, with certain modifications: reporting frequency to be no more than weekly, the required date elements may be modified in the future at the discretion of the Secretary, and the reporting requirements will sunset as of December 31, 2024.
The final rule is scheduled to be printed in the Federal Register on November 9, 2021. A display copy is available here. The CMS fact sheet is available here.
