New Home Health Proposed Rule

The U.S. Centers for Medicare & Medicaid Services (CMS) released its 387 page new home health proposed payment rule last Monday, while also announcing plans for the nationwide expansion of the industry’s value-based purchasing demonstration beginning January 1, 2022.

The summary of the rule as stated in the Federal Register can be found below, however, an article by Joyce Famakinwa in Home Health Care News , which can be accessed through the following link, also does a great job of hitting the most important highlights of the proposed rule and presenting them with historical context: https://homehealthcarenews.com/2021/06/extensive-proposed-rule-sets-stage-for-value-based-purchasing-pdgm-adjustments/ . In addition to the highlighted changes, the rule establishes survey and enforcement requirements for hospice programs as set forth in Division CC, section 407, of the CAA 2021.

CMS-1747-P

On June 28, 2021, The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1747-P) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2022. The proposed rule results in an estimated 1.7 percent increase ($310 million) in payments to HHAs in CY 2022.

Additionally, this rule provides monitoring and analysis of the Patient-Driven Groupings Model (PDGM); solicits comments on a methodology for determining the difference between assumed versus actual behavior change on estimated aggregate expenditures for home health payments as result of the change in the unit of payment to 30 days and the implementation of the PDGM case-mix adjustment methodology; proposes to maintain the CY 2021 low utilization payment adjustment (LUPA) thresholds; and proposes to recalibrate the PDGM case-mix weights, functional levels, and comorbidity adjustment subgroups for CY 2022.  This rule also proposes to utilize the physical therapy LUPA add-on factor to establish the occupational therapy add-on factor for the LUPA add-on payment amounts; and make conforming regulations text changes to reflect that allowed practitioners are able to establish and review the plan of care. Finally, this rule includes updates to the home infusion therapy services payment rates for CY 2022, as required by section 1834(u) of the Act.

A Home Health Claims-OASIS Limited Data Set (LDS) file will be made available, upon request, to accompany the CY 2022 HH PPS proposed rule. Please visit the Home Health Prospective Payment System (HH PPS) Limited Data Set (LDS) webpage for more information.

Proposed Rule Fact Sheet:  https://www.cms.gov/newsroom/fact-sheets/cms-proposes-calendar-year-2022-home-health-prospective-payment-system-rate-update

Proposed Rule:  https://public-inspection.federalregister.gov/2021-13763.pdf