Medicare home health providers pay to increase

The Centers for Medicare and Medicaid Services has launched a plan to reduce home medical reimbursements by $810 million next year and will give providers a 0.7% pay raise to $125 million.

CMS announced on Monday the final rule that sets out Medicare fees for home health services next year. Family health industry groups vehemently oppose the proposed cuts and threaten to sue if CMS implements them.

In a proposed rule published in June, CMS argued that the cuts were necessary to accommodate payments in excess of $2 billion made in 2020 and 2021 during the implementation of the Distribution Model. patient-oriented grouping, a new method of payment, in 2020. Patient-oriented clustering model is based on reimbursement on the basis of patient characteristics rather than hours of treatment provided.

Instead, CMS will reduce payments in stages to predict home health providers will pay for the highest paying codes under the Patient-Driven Clustering Model. “We recognize the potential difficulty of implementing the proposed full permanent adjustment in a single year,” the agency wrote in the final rule.

According to a spokesman, the Quality Home Healthcare Partnership is reviewing the final rule. Industry groups including partnerships have backed a bipartisan bill, the Home Health Access Preservation Act of 2022, that would delay payment cuts for home health until 2026 .

The final rule also limits the amount CMS can reduce Medicare payroll index payments to 5%. In addition, the regulation establishes a benchmarking framework for an expanded Home Health Value-Based Purchasing Model. Regardless of whether the home health agency is certified Medicare, they will use January 1, 2022 as their base year.

CMS also requires home health agencies to submit assessment and outcome data for non-Medicare and non-Medicaid patients beginning in 2025. CMS previously suspended data collection.