The Centers for Medicare & Medicaid Services (CMS) announced on 07/05/11 at 4:15pm a number of proposed changes to Medicare home health payments for 2012 that if finalized will promote greater efficiency and payment accuracy.
A proposed rule was displayed at the Federal Register proposing a 3.35 percent decrease in Medicare payments to home health agencies (HHAs) for calendar year (CY) 2012. This would be an estimated net decrease of $640 million compared to HHA payments in CY 2011. It would include the combined effects of market basket and wage index updates (a $310 million increase) and reductions to the home health prospective payment system (HH PPS) rates to account for increases in aggregate case-mix that are largely related to billing practices and not related to changes in the health status of patients (a $950 million decrease).
Provisions of the Affordable Care Act (ACA) mandate that CMS apply a one (1) percentage point reduction to the CY 2012 home health market basket amount; this would equate to a proposed 1.5 percent update for HHAs next year. As part of the HH PPS rate update, CMS also proposes to reduce HH PPS rates by 5.06 percent in CY 2012 to account for the increase in the case-mix that is unrelated to changes in patient acuity.
The Medicare HHA proposed rule would also make structural changes to the HH PPS by removing two hypertension codes from the case-mix system (401.1 & 401.9), lowering payments for high therapy episodes and recalibrating the HH PPS case-mix weights to ensure that these changes result in the same amount of total aggregate payments.
Comments should be received no later than than 5 p.m. on Sept. 6, 2011. Click here for the actual publication - CMS-1353-P
