Takeaway: Should be uneventful as CMS spends time and resources on developing alternative payment model for CY 2020

The last of the annual Medicare reimbursement rule updates, for the CY 2019 Home Health Prospective Payment System, was sent to the White House May 9.

MEDICARE RULE-A-RAMA | PROPOSED HOME HEALTH RULE BEING REVIEWED BY WHITE HOUSE - 2019 Rule List

The update should be quite uneventful as CMS prepares to spend the next 12 to 18 months trying to find consensus in the industry around implementation of a new home health payment system which must go into effect in 2020 pursuant to the Bipartisan Budget Act of 2018. However, we would expect CMS to use the rulemaking process to provide information on the process they plan to engage in developing that consensus.

That process will include Congress’ directive for CMS to convene at least one Technical Expert Panel between Jan. 1, 2018, and Dec. 31, 2018, to consider the merits of the Home Health Grouping Model or alternative models “that were submitted during 2017 as comments in response to proposed rule making, including patient-focused factors that consider the risks of hospitalization and readmission to a hospital, improvement or maintenance of functionality of individuals to increase the capacity for self-care, quality of care and resource utilization.”

Industry offered a number of suggestions but one of the most thoughtful and comprehensive and that clearly considers the same factors identified by Congress was submitted by the folks at AFAM. Read the entire comment letter here.

In December, Kate Jones of Caring Experts and I covered a number of the major industry concerns on a thought leader call. A Technical Expert Panel convened in February, before passage of the BBA, also consider most of the major objections. The slide deck from the meeting can be found here.

MEDICARE RULE-A-RAMA | PROPOSED HOME HEALTH RULE BEING REVIEWED BY WHITE HOUSE - Home health update

Other things to watch for:

Physician certification and re-certification: In the BBA 2018, Congress provided a modest amount of relief to the pesky face-to-face requirement that has artificially driven the home health improper payment rate above 10 percent. Instead of relying solely on medical records of a physician or a discharging facility, a home health agency may also use its own medical records to support documentation of the admission.

This change is not what the industry sought. They wanted repeal of the face-to-face requirement or at least some relief from those recalcitrant physicians who don’t like to complete paperwork. However, the change should provide some relief in CY 2019 and CMS will use the pending rule to provide their interpretation of the statute.

Administrative burden. As has been the case with each of the Medicare payment rules, the home health update should include provisions to reduce administrative burden. Under the Meaningful Measures initiative, CMS has used rulemaking to eliminate quality measures that had limited value or were assessing process rather than outcomes. CMS undertook some changes last summer as we expect them to continue to evaluate changes and make proposals this year.

Call with questions after you have enjoyed your Memorial Day holiday.

Emily Evans
Managing Director
Health Policy


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