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The Centers for Medicare & Medicaid Services (CMS) has issued the proposed rule for the home health prospective payment system (PPS) for calendar year (CY) 2024.
Based on the updates described in the rule, CMS estimates that overall Medicare payments to home health agencies will decrease by 2.2%, or by $375 million compared to CY 2023. The decrease is the result of routine statutorily required updates as well as proposed rebasing of the home health market basket, updates to the labor-related share, and recalibration of the Patient-Driven Groupings Model (PDGM) case-weights. CMS proposes a permanent prospective adjustment of minus 5.653% to the CY 2024 home health payment rate to address actual and assumed behavioral changes occurring as a result of the implementation of the PDGM and the 30-day unit of payment. CMS also proposes to codify requirements for negative pressure wound therapy and to establish regulations to implement payment for items and services under two new benefits: lymphedema compression treatment and home intravenous globulin. In addition, CMS proposes several changes to the expanded home health value-based purchasing model.
Proposals for changes to the home health quality reporting program (QRP) align with previously released proposed rules for the PPS for long-term acute care hospitals, inpatient rehabilitation facilities, and skilled-nursing facilities. CMS proposes the adoption of two new measures, including the percentage of patients/residents who are up to date for COVID-19 vaccination and a new functional discharge score measure. CMS also proposes the removal of a current QRP measure addressing functional assessment and care plan, as well as two OASIS items that CMS deems no longer necessary. Proposed additions to public reporting include the discharge function measures, transfer of health measures for providers and for patients, and COVID-19 patient/resident vaccine rates.
Finally, CMS is proposing several provisions to address concerns about unnecessary utilization, costs, and care quality, including changes to policies regarding durable medical equipment, prosthetics, orthotics, and supplies refills, requirements for hospice enrollment, and provisions of the hospice special focus program required by the Consolidated Appropriations Act of 2021.
CHA will provide members with a more complete summary in the near future. Comments on the proposed rule are due Aug. 29. Finalized provisions will become effective Jan. 1, 2024.
