CMS Releases 2019 Medicare Home Health Proposed Rule

Posted on July 05, 2018

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule to update the Medicare fee-for-service home health (HH) prospective payment system (PPS) for calendar year 2019. Highlights of the proposed rule include:

  • A net 2.1 percent increase in HH payment rates after the 2.7 percent marketbasket update is adjusted by:
    • The negative 0.7 percent productivity adjustment.
    • A 0.1 percent increase in high-cost outlier payments due to lowering the fixed dollar loss ratio.
    • A 0.1 percent decrease in payments due to the rural add-on methodology that applies varying add-on payments for 2019 through 2022 based on an HH agency’s rural county designation.
  • A complete redesign of the HH PPS in 2020, as mandated by the Bipartisan Budget Act of 2018, by replacing the existing therapy-based payment system with a new model known as the patient-driven groupings model. This model would be budget-neutral overall, but would increase payments for facility-based HH agencies by nearly 4 percent.
  • A move to 30-day periods of care rather than the current 60-day periods.
  • The removal of seven quality measures from the HH Quality Reporting Program.
  • The creation of safety and payment standards for new home infusion therapy services and implementation of transitional payments for these services in 2019 and 2020.
  • The addition of two new requirements for all accreditation organizations. 

Over the next few weeks, the MHA will distribute facility-specific impact analyses and summary of the proposed rule. In addition, the MHA will make its draft comments available prior to the Aug. 31 due date and encourages members to submit comments to the CMS. The CMS is expected to release a final rule by Nov. 1 for the Jan. 1, 2019, effective date. Members with questions should contact Vickie Kunz at the MHA. 

Tags: Medicare, home health, PPS, Medicare fee-for-services

Posted in: Member News

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