Updated Nov. 3 at 7:22 a.m. with statement from Bill Dombi.

WASHINGTON, D.C. (November 2, 2021)—The Centers for Medicare & Medicaid Services (CMS) issued its awaited final rule affecting home health today, expanding the Home Health Value-Based Purchasing Model (HHVBP) and increasing payment rates for home health by 3.2% in 2022. 

CMS is figuring to pay about $570 million more in Medicare payments to home health agencies (HHAs) in 2022. That reflects reflects a payment update of 2.6%, a .7% increase due to the fixed-dollar loss ratio, and a .1 percent decrease in payments that came from changes to the rural add-on percentages. 

According to a fact sheet provided by CMS, the final rule also makes permanent the changes to the home health Conditions of Participation (CoP) that were implemented during the COVID-19 public health emergency and finalizes changes to the CoPs to implement a provision of the Consolidated Appropriations Act, 2021.

It also:

  • finalizes changes to the Home Health, Long-Term Care Hospital (LTCH), and Inpatient Rehabilitation Facility (IRF) Quality Reporting Programs (QRP);
  • finalizes revisions to the infection control requirements for Long-Term Care Facilities (Medicaid nursing facilities and Medicare skilled nursing facilities, also collectively known as “nursing homes”) that will extend the mandatory COVID-19 reporting requirements beyond the current COVID-19 PHE until December 31, 2024;
  • incorporates into regulation several existing Medicare provider enrollment policies;
  • finalizes survey and enforcement requirements for hospice programs to implement provisions of the Consolidated Appropriations Act, 2021;
  • recalibrates some case-mix weights under the Patient Driven Groupings Model while maintaining the current thresholds for low utilization payment adjustments (LUPAs) "to more accurately pay for the types of patients (agencies) are serving;"
  • establishes a LUPA add-on factor for skilled occupational therapy; and
  • updates home infusion therapy services payments, expected to come in overall at a 5.1% increase. 

In the release, CMS said the rule furthers CMS’s strategic commitment to drive innovation that promotes comprehensive, person-centered care for older adults and people with disabilities by accelerating the shift from paying for home health services based on volume, to a system that incentivizes value and quality and is designed to incentivize quality care improvements. 

"CMS is committed to helping people get the care they need, where they need it,” said CMS Administrator Chiquita Brooks-LaSure. “This final rule will improve the delivery of home health services for people with Medicare. It will also improve our data collection efforts, helping us to identify health disparities and advance health equity.”

The National Association for Homecare & Hospice (NAHC) said it was analyzing the provisions of the rule. It plans to hold two webinars on Friday to walk through it with providers; you can sign up here. 

However, NAHC president Bill Dombi provided this statement, “The Center for Medicare & Medicaid Services’ 528-page is a combination of significant and minor changes in the home health payment model and conditions of participation along with the expected expansion of the Home Health Value-Based Purchasing and establishment of enhanced survey and certification standards for hospices. As expected, CMS has tweaked quality measures for home health and updated the home infusion therapy payment under Medicare Part B."

“All told,” continued Dombi, “the final rule is a combination of standard adjustments, reasonable policy actions during a continued Public Health Emergency, sensible postponements in policy reforms, and unfortunate rejections of some recommendations, such as a consistent wage index policy, that would protect access to care. NAHC agrees that CMS needed to be cautious at this unsettled time, and we recommended 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 CMS Innovation Center (Innovation Center) launched the original HHVBP Model on Jan. 1, 2016, to determine whether CMS could improve the quality and delivery of home health care services to people with Medicare by offering financial incentives to providers that offer better quality of care with greater efficiency. The original HHVBP Model comprised all Medicare-certified home health agencies (HHAs) providing services across nine randomly selected states. The Third Annual Evaluation Report of the participants’ performance from 2016-2018 showed an average 4.6% improvement in HHAs’ quality scores and an average annual savings of $141 million to  Medicare.

The final policies promulgated in this rule expand the HHVBP Model nationally, with the first performance year beginning Jan. 1, 2023. The HHVBP Model is one of four Innovation Center models that have met the requirements to be expanded in duration and scope since 2010. Starting in 2025, CMS will adjust fee-for-service payments to Medicare-certified HHAs based on the quality of care provided to beneficiaries during the CY 2023 performance year. Throughout 2022, CMS will provide technical assistance to HHAs to ensure they understand how performance will be assessed. Overall, these policies support the Agency’s commitment to advancing value-based care by providing incentives for HHAs to improve the beneficiary experience and quality of care.

Additionally, the final rule will advance CMS’s coordination of care efforts through improvements to the Home Health Quality Reporting Program, Long-Term Care Hospital Quality Reporting Program, and Inpatient Rehabilitation Facility Quality Reporting Program and finalizes the mandatory COVID-19 reporting requirements for Long Term Care facilities (nursing homes) established as a part of the May 2020 and May 2021 Interim Final Rules beyond the current COVID-19 public health emergency (PHE)  until Dec. 31, 2024. The rule removes or replaces several quality measures to reduce burden and increase focus on patient outcomes. CMS is also finalizing its proposals to begin collecting data on two measures promoting coordination of care in the Home Health Quality Reporting Program effective Jan. 1, 2023 as well as measures under Long-Term Care Hospital Quality Reporting Program and Inpatient Rehabilitation Quality Reporting Program effective Oct. 1, 2022. The effective dates position the agency to support the recent Executive Order 13985 of Jan. 20, 2021, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government.

Finally, this rule implements provisions of the Consolidated Appropriations Act, 2021 that establish survey and enforcement requirements for hospice programs serving Medicare beneficiaries. These provisions will require the use of multidisciplinary survey teams, prohibition of surveyor conflicts of interest, and expansion of  surveyor training to include accrediting organizations (AOs). The provisions also establish a hospice program complaint hotline and create the authority for CMS to impose enforcement remedies for noncompliant hospice programs. These changes will strengthen oversight, enhance enforcement, and establish consistent and transparent survey requirements in hospice care.

For a fact sheet on the proposed rule click here.

The Final Rule can be downloaded here.