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  • Home Health Payment for 2016 Includes New Value-Based Model, Slightly Smaller Reduction From Proposed Rule

    The Centers for Medicare and Medicaid Services (CMS) has issued a final rule for the 2016 Medicare home health prospective payment system (HH PPS) that looks a lot like the rule it proposed earlier this year: a set of changes that includes an estimated overall 1.4% payment reduction smaller than the reduction originally proposed, and the introduction of a new value-based model that will be used in 9 states.

    APTA regulatory affairs staff is reviewing the final rule and will develop a more detailed summary of its provisions in the coming weeks. In the meantime, here are some key features of the changes that will be happening next year.

    Payment. Overall, CMS projects that payment adjustments will result in an estimated 1.4% reduction, or $260 million in 2016. This is a slight decrease from the proposed rule, which estimated a 1.8% overall reduction. CMS arrived at the overall estimate by weighing a 1.9% payment update against various decreases including reductions in the 60-day episode payment rate, per-visit payment rates, and nonroutine medical supplies. The rule also includes cuts in each of 2016 and 2017 to account for estimated case mix growth.

    Home Health Quality Reporting Program. CMS will add 1 standardized cross-setting measure—reports on new or worsened pressure ulcers—to the Home Health Quality Reporting Program. As in the proposed rule, the final rule also requires home health agencies (HHAs) to submit both admission and discharge OASIS assessments for at least 70% of all patients whose episodes of care occurred during the reporting period starting July 1, 2015. The threshold will increase by 10% in each of 2016 and 2017 to reach 90%.

    Value-Based Payment Model. HHAs in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington will participate in a new value-based payment system. Beginning in 2018, the HHAs in these states will receive payment increases or reductions based on 2016 performance data. The adjustment process will continue each year from 2018 to 2022, with the range of payment adjustment increasing along the way, from a potential 5% increase or decrease in 2018 to an 8% adjustment upward or downward in 2021 and 2022. CMS anticipates saving $380 million through reductions in unnecessary hospitalizations and skilled nursing facility usage through this model.


    • What measures are CMS going to be looking at for the 9 states under the value based system?

      Posted by Steve Noveshen on 11/11/2015 3:38 PM

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