On July 2, 2018, CMS issued a proposed rule (CMS-1689-P) outlining proposed Calendar Year (CY) 2019 Medicare payment updates and proposed quality reporting changes for home health agencies (HHAs). CMS projects that payments to HHAs in CY 2019 would be increased by 2.1 percent based on proposed policies, but also includes significant changes to home health case-mix groupings.

The proposed rule contains the following proposed changes, among others:

• As mandated by the Bipartisan Budget Act of 2018, the proposed rule would implement a new Patient-Driven Groupings Model (PDGM) for home health payments. CMS explains that the PDGM focuses on patient clinical characteristics and other patient information to allow payments to more closely mirror patients’ needs. The PDGM would eliminate the use of “therapy thresholds” in determining payment and change the unit of payment from 60- to 30-day periods of care.
• CMS proposes to define remote patient monitoring for the Medicare home health benefit and to include the cost of remote patient monitoring as an allowable cost on the HHA cost report in an effort to encourage more HHAs to adopt this technology.
• The proposed rule includes information regarding the implementation of home infusion therapy temporary transitional payments that are also required by the Bipartisan Budget Act of 2018. Further, the proposed rule requests feedback on elements of the new home infusion therapy benefit category and proposes standards for home infusion therapy suppliers and accrediting organizations.
• CMS proposes updates to measures for the Home Health Quality Reporting Program and the Home Health Value-Based Purchasing Model.
• CMS also proposes to eliminate the requirement that a certifying physician ordering home health services must estimate how much longer skilled services would be needed when recertifying the need for continuing home health care.
• The proposed rule also contains a Request for Information soliciting feedback on solutions to better achieve sharing of healthcare data between providers.

Comments are due by August 31, 2018.

The proposed rule is available here, and the CMS factsheet is available here.