CMS Releases Home Health Prospective Payment System Final Rule for CY 2013


[author: Mark A. Stanley]

CMS has released its calendar year 2013 final rule [PDF] for payments to Home Health Agencies. The rule anticipates that payments to home health agencies will remain virtually unchanged next year, with a total reduction of about $10 million (0.01 percent) in payments. This reflects a 1.3 percent home health payment reduction, an update to the wage index, an updated fixed-dollar loss ratio, and an adjustment to case-mix coding. Among other changes, the rule:

  • Rebases and revises the home health market basket update, resulting in a labor-related share of 78.535 percent and a non-labor share of 21.465 percent;
  • Allows a nonphysician practitioner (NPP) in an acute or post-acute facility to perform, with the supervision or collaboration of a physician, the face-to-face encounter required to certify a patient for home health care;
  • Resumes Medicare coverage for therapy services that were suspended due to a late reassessment with the visit at which the reassessment is performed (as opposed to the visit after the reassessment);
  • Provides new compliance options and alternative sanctions for home health agencies that are out of compliance with conditions of participation. The effective date of the provisions regarding civil monetary penalties, suspension of payments for new admissions and informal dispute resolution is July 1, 2014; other provisions are effective July 1, 2013;
  • Establishes new survey and certification requirements, including types of surveys, survey frequency, and surveyor qualifications, effective July 1, 2013;
  • Extends hospice quality reporting measures, originally applicable only through CY 2014, to subsequent years.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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