CMS released the CY2017 Home Health Final Rule on October 31, 2016. The payment rate portion of the rule is consistent with the proposed rule, with only minor modifications, resulting in a slight rate reduction from 2016 rates.
Some important items to note include:
HHAs who have a high volume of outlier visits may see a decrease in their payment amount due to the methodology change for calculation of outlier payments. CMS is moving from a cost per visit approach to a cost per unit approach (1 unit = 15 minutes) and is putting a cap on the amount of time per day that can be counted toward the estimation of an episode’s cost for outliers (limited to 8 hours or 32 units per day).
CMS is finalizing the following changes to the Home Health Value-Based Purchasing (HHVBP) Model:
- Calculate benchmarks and achievement thresholds at the state level rather than based on smaller/larger-volume cohort levels, eliminating increased variation caused by having too few HHAs in a cohort.
- Increase the timeframe for submitting New Measure data from seven calendar days to fifteen calendar days following the end of each reporting period to account for weekends and holidays
- Remove four measures (Care Management: Types and Sources of Assistance, Prior Functioning ADL/IADL, Influenza Vaccine Data Collection Period, and Reason Pneumococcal Vaccine Not Received) from the set of applicable measures
- Adjust the reporting period and submission date for the Influenza Vaccination Coverage for Home Health Personnel measure from a quarterly submission to an annual submission beginning April 2017
- Implement an appeals process for HHAs to request recalculation of the Interim Performance Report scores and/or the Annual TPS and Payment Adjustment Report scores. Agencies seeking recalculation will be required to submit their request within 15 calendar days of the scores being posted on the HHVBP Secure portal. In addition, reconsideration requests must be submitted within 15 days of receiving notification of the recalculation results. The final TPS and payment adjustment percentage is provided to competing HHAs in a final report no later than 30 days in advance of the payment adjustment taking effect.