CMS Issues Final Rule for CY 2020 Home Health Payments, CY 2021 Home Infusion Therapy Benefit

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On October 31, 2019, CMS issued a final rule with comment period (Final Rule), CMS-1711-FC, updating the payment rates for home health agencies (HHAs) for calendar year (CY) 2020. As explained below, the Final Rule also:

  • Modifies quality reporting measures for HHAs;
  • Updates reporting requirements of performance scores affecting HHAs;
  • Finalizes the CY 2021 home infusion therapy benefit payment system; and
  • Permits therapist assistants to furnish maintenance therapy under the home health benefit.

The Final Rule is effective January 1, 2020, and comments solicited by the Final Rule are due on December 30, 2019.

Updates to the Home Health Prospective Payment System (HH PPS)

The Final Rule changes the unit of home health payment from 60-day episodes of care to 30-day periods of care, and it introduces a 30-day payment amount for CY 2020.

As required under the Bipartisan Budget Act of 2018, the Final Rule implements the Patient-Driven Groupings Model (PDGM), which is an alternate case-mix adjustment methodology featuring a 30-day unit of payment for home health periods of care beginning January 1, 2020. The CY 2020 30-day payment amount will be $1,864.03. CMS projects that aggregate payments to HHAs in CY 2020 will increase 1.3 percent.

Update to Home Health Value-Based Purchasing (HHVBP) Model

Consistent with CMS’s goal of providing data for comparisons among HHAs, the Final Rule also includes a finalized requirement for public reporting of Total Performance Scores (TPS) and TPS Percentile Rankings from Performance Year 5 (CY 2020) Annual TPS and Payment Adjustment Reports for the home health agencies in the 9 Model states that qualified for a CY 2020 payment adjustment. CMS anticipates releasing the data after December 1, 2021 (after its completion of annual reports for HHAs).

Update to Home Health Quality Reporting Program (HH QRP)

The Final Rule also updated the Home Health Quality Reporting Program (HH QRP), in which HHAs are required to submit quality measure and standardized patient assessment data or face a two percent reduction to their market basket increase for the year involved. The HH QRP currently has 19 quality measures, but the Final Rule updated those measures in the following ways:

  • Removal of a quality measure (the Improvement in Pain Interfering with Activity Measure) consistent with efforts to “mitigate any potential unintended, over-prescription of opioid medications inadvertently driven by this measure.” However, CMS is not removing, based on stakeholder feedback, Question 10 from HH Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, which asks, “In the last 2 months of care, did you and a home health provider from this agency talk about pain?”
  • Adoption of two new quality measures regarding the assessment of transfers of health information, dubbed the “Transfer of Health Information to Provider-Post-Acute Care” and “Transfer of Health Information to Patient-Post-Acute Care” measures.

Beginning in CY 2022, HHAs are also required to report standardized patient assessment data related to quality measures and the standardized patient assessment data elements (SPADEs) under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act. CMS is working to finalize additional SPADEs to fulfill IMPACT Act requirements and improve coordinate of care, among other things.

Update to Home Infusion Therapy Payments

Section 5012 of the 21st Century Cures Act established a new Medicare home infusion therapy benefit and a temporary transitional payment through the end of CY 2020. The Final Rule accomplishes the implementation of a permanent home infusion therapy services payment system required by the Act.

The CY 2020 HH PPS Final Rule features the home infusion therapy payment rates for CY 2021 “to provide sufficient time for providers and suppliers to prepare for the full implementation” of the new home infusion therapy benefit. These payment provisions will apply after the home infusion therapy services temporary transitional payments expire in 2020. CMS created three payment categories for home infusion therapy drugs that will be paid at amounts under the Physician Fee Schedule (PFS). However, CMS will pay more for initial home infusion therapy visits to “account for costs to initiate these services.” According to CMS, the home infusion drugs must be administered intravenously at home through a pump qualifying as durable medical equipment (DME).

The Final Rule also solicits comments on the future of policies governing coverage of eligible home infusion therapy drugs.

Updates for Therapist Assistant Roles

The Final Rule also permits therapist assistants to perform maintenance therapy under the Medicare home health benefit, bringing these roles in line with those permitted in skilled nursing facilities (SNFs), where therapist assistants already are permitted to perform maintenance therapy. This change, according to CMS, will provide HHAs with greater flexibility in deploying therapists and therapist assistants.

The current version of the Final Rule is available online here, and the CMS Fact Sheet is available here. The Final Rule is scheduled to be published in the Federal Register on November 8, 2019.

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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