2014 Home Health Proposed Rule Includes Drastic Payment Changes

Proposed Rule Changes Require Action.

Last week, CMS issued the 2014 Home Health PPS Proposed Rule, which included some very drastic payment changes. On Friday, I participated in the Home Care and Hospice Managers Association call which outlined some of the proposed changes and an action plan that the National Association for Homecare and Hospice (NAHC) is putting together to fight the proposal. Some of the high level changes included in the proposed rule are:

  • Reducing Medicare payments 1.5%. The proposed decrease reflects the effects of the 2.4% home health payment update, the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates and the non-routine medical supplies (NRS) conversion factor and the effects of ICD-9-CM coding adjustments.  As part of rebasing, CMS is proposing to make significant changes in case mix weights by resetting the 2014 average case-mix weight to 1.00.
  • Setting the national, standardized 60-day episode payment for CY 2014 to $2,860.20. While this base rate is higher than the current 2013 amount, the case mix weights would be recalibrated to a 1.0 starting point and then the base rate combined with across-the-board lower case mix weights would result in a net payment decline.
  • Removing two categories of ICD-9-CM codes from the HH PPS Grouper. Codes that are “too acute,” meaning the condition could not be appropriately cared for in a home health setting; and diagnosis codes for conditions that would not impact the home health plan of care, or would not result in additional resources when providing home health services to the beneficiary.

HEALTHCAREfirst will be discussing the proposed rule in detail in the upcoming Home Health Regulatory webinar that is scheduled for July 30th. An outline of the agenda for the upcoming webinar is as follows:

  • 2014 PPS Proposed Rule/Payment Update
      • Add two claims-based home health quality measures: Re-hospitalizations and emergency department use
      • Across-the-board reduction to case-mix weights
      • Remove 170 codes from the HH PPS Grouper effective Jan. 1
      • Allocate costs for home health Medicaid surveys
  • Update on ICD-10
  • Home Health Audits and Edits
  • Potential changes on the horizon
  • Medicare Administrative Contractors

Additional details about this free webinar will be made available shortly.

A link to the proposed rule and the following three files can be accessed here: