The Centers for Medicare & Medicaid Services (CMS) has issued the final rule for the prospective payment system (PPS) for home health agencies (HHAs) for calendar year (CY) 2020. The provisions in the rule will be effective Jan. 1, 2020.
CMS finalizes the implementation of an alternate case-mix methodology with a 30-day unit of payment, the Patient-Driven Groupings Model (PDGM). CMS also finalizes a 1.5% payment update factor adjusted by a 0.2% aggregate decrease due to changes in the rural add-on percentages, estimating that overall Medicare payments will increase by 1.3%, or $250 million, as compared to CY 2019.
Notably, CMS limits the application of the proposed behavioral assumptions that are directed at offsetting provider behavior changes under PDGM, resulting in a smaller adjustment to the 30-day payment amount. The finalized CY 2020 30-day payment amount for HHAs reporting quality data is $1,864.03.
CMS also finalizes changes that will reduce the split payment percentage amount in CY 2020 and eliminate such payments in CY 2021, as well as its proposal to allow therapist assistants to provide maintenance therapy.
Additionally, the final rule makes several changes to the home health quality reporting program (HH QRP) as required by the Improving Medicare Post-Acute Care Transformation Act (IMPACT Act). CMS will proceed with removing the Improvement in Pain Interfering with Activity Measure from the HH QRP. However, based on member comments, question 10 of the Home Health Care Consumer Assessment of Healthcare Providers & Systems — “In the last 2 months of care, did you and a home health provider from the agency talk about pain?” — will be retained.
The rule also finalizes payment policies to prepare for full implementation of the new home infusion therapy benefit, which will occur in CY 2021, and requests comments about how to enhance coverage of eligible drugs under the home infusion benefit.
CHA will release a detailed summary of the final rule in the coming weeks.