CMS Proposed Rule Hikes Home Health Payments by $310m, Expands HHVBP

WASHINGTON, DC (June 29, 2021)—The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would increase Medicare payments to home health agencies by $310 million in 2022 and expand the Home Health Value-Based Purchasing (HHVBP) Model nationwide.

In addition to a 1.7% increase in overall payments to home health agencies, the rule adjusts payments for home infusion therapy and makes permanent changes to the home health Conditions of Participation (CoP) implemented during the COVID-19 public health emergency.

“Homebound Medicare patients face a unique set of challenges and barriers to getting the care they need,” CMS Administrator Chiquita Brooks-LaSure said in a news release. “(This) announcement is a reaffirmation of our commitment to these older adults and people with disabilities who are counting on Medicare for the health care they need. This proposed rule would streamline service delivery and value quality over quantity—at a time when Americans need it most.”

The rule actually proposes a 1.8% increase in home health payments or $330 million, but that is offset by $20 million in reductions due to the rural add-on percentages.  

The 387-page proposed rule includes both significant and minor changes to the home health payment model and conditions of participation, as well as tweaking quality measures for home health and enhancing some survey and certification standards for hospices, said Bill Dombi, president of the National Association for Homecare & Hospice.

“All told, the proposed rule is complex, ambitious and cautious at a time when the public health emergency continues,” Dombi said. “NAHC agrees that CMS should be cautious at this unsettled time and we recommend CMS avoid taking premature steps that could disrupt a fragile health care system based on a myriad of assumptions and limited data from a chaotic period. In that respect, NAHC appreciates that CMS is avoiding taking potential actions without reliance on comprehensive data.” 

The rule would implement the HHVBP Model, which was introduced in 2016, nationwide. It is currently operating in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington; those states would see their model programs end a year early and the first performance year of the nationwide model would be 2022.

CMS is also suggesting that some of the regulatory waivers issued during the pandemic—especially related to telecommunications and home health aide (HHA) supervision—be made permanent past the PHE.

“We believe the current 14-day on-site supervisory visit requirement when a patient is receiving skilled services is an important component to assessing the quality of care and services provided by the HHA aide, and to ensure that aide services are meeting the patient’s needs,” the agency wrote in a fact sheet. “While we are proposing to allow this telecommunications flexibility, we expect that in most instances, the HHAs would plan to conduct the 14-day supervisory assessment during an on-site, in person visit, and that the HHA would use interactive telecommunications systems option only for unplanned occurrences that would otherwise interrupt scheduled in-person visits.”

The extensive proposal also includes CMS’ latest analysis of PDGM data—including admission source, timing, clinical grouping, functional impairment level, comorbidity adjustment and physical, occupational and speech therapy visits—and solicits comments on its method for analysis. It doesn’t suggest any specific adjustments to the behavioral assumptions at this time.

It does, however, suggest recalibrating case-mix weights, functional levels and comorbidity adjustment subgroups using 2020 data. And it says this year’s low utilization payment adjustments (LUPA) threshholds should remain in 2022.

Other changes in the proposed rule include:

• Using the physical therapy LUPA add-on factor to temporarily calculate LUPA add-on payment amounts for the first skilled occupational therapy (OT) visit in LUPA periods because OTs can now conduct initial assessments for Medicare beneficiaries when skilled nursing isn’t in the plan of care;
• Updating payment rates for home infusion therapy services and geographic adjustment factor used for wage adjustment; it says the “overall economic impact … is expected to be minimal;”
• Adjusting the Home Health Quality Reporting Program (HH QRP) in an effort to reduce disparities in health equity and standardize outcomes; it suggests removing an OASIS-based measure and requests comments on the possibility of expanding measures and data collection;
• Seeks feedback on plans to define digital quality measures for the HH QRP and on the potential use of Fast Healthcare Interoperability Resources;
• Enhances hospice survey processes, expanding surveyor training to accrediting organizations and creating a complaint hotline as well as creating a program for poor-performing programs and enforcement options for non-compliant hospices.