On February 9, 2018, President Trump signed into law H.R. 1892, the Bipartisan Budget Act of 2018. The 640-page legislation is a two-year budget plan that contains several provisions that will affect home health and hospice agencies, including the creation of a new payment model and loosened rules regarding review of documentation for face to face visits.
Here are some highlights of what home health and hospice agencies can expect, along with comments taken from a recent webinar hosted by the National Association for Homecare and Hospice (NAHC) on the act:
SEC. 51001. HOME HEALTH PAYMENT REFORM
The revised payment system included in the Bipartisan Budget Act of 2018 would begin on January 1, 2020. Similar to the HHGM model, it calls for payment amounts to be based on a 30-day unit of service. However, unlike the HHGM model, this payment system is budget neutral. According to Home Health News, the HHGM model proposed in 2017 would have potentially cut approximately $950 million in payments if implemented in a non-budget neutral manner.
For 2020 and subsequent years, the therapy thresholds in case mix adjustment factors for calculating payments will be eliminated.
According to NAHC, these provisions are a result of lobbying compromise, but have a net positive effect since they allow for further refinement of payment reform. No changes will be required for 60 day OASIS and plan of care requirements.
NAHC intends to offer amendment language to Congress to change the start date to “No earlier than 2020” to ensure adequate time for agencies to prepare. NAHC notes that the use of RAPs will likely continue but are unsure if value-based purchasing will continue.
It expects CMS will include, as proposed, a higher payment for first episodes. LUPA changes are still on the table to be revisited to avoid gaming.
In addition, HHS is directed to consult with a Technical Expert Panel on revision of case-mix, “not later than December 31, 2019, the Secretary of Health and Human Services shall pursue notice and comment rulemaking on a case-mix system with respect to the prospective payment system for home health services under section.”
SEC. 51002. SATISFY DOCUMENTATION OF MEDICARE ELIGIBILITY FOR HOME HEALTH SERVICES
Documentation requirements are amended as follows: “For purposes of documentation for physician certification and recertification made under paragraph (2) on or after January 1, 2019, …, in addition to using documentation in the medical record of the physician who so certifies or the medical record of the acute or post-acute care facility …the Secretary may use documentation in the medical record of the home health agency as supporting material, as appropriate to the case involved.”
This represents a loosening of current face to face documentation requirements. Reviewers “may use” documentation in a home health agency’s medical record as supportive material to prove that a patient is homebound and requires skilled care. NAHC will attempt to get Congress to correct the language from “may use” to “shall use” to ensure that documentation in the home health agency’s medical record is required to be used. It will also be very important that agencies focus on creating complete and accurate documentation to ensure that the medical record clearly supports the need for home health care.
SEC. 50208. EXTENSION OF HOME HEALTH RURAL ADD-ON
This extends the 3% rural add-on to January 1, 2019. In 2019, the add-on payments will change and will reduce over time. NAHC encouraged providers to stay tuned for further information to be contained in the payment update this summer.
SEC. 53110. MEDICARE PAYMENT UPDATE FOR HOME HEALTH SERVICES.
The Bipartisan Budget Act of 2018 amended market basket updates for 2020 and after to 1.5%. In trending forward, this will likely be an adequate update amount since the productivity adjustment will no longer be in place.
SEC. 50302. EXPANDING ACCESS TO HOME DIALYSIS THERAPY.
An individual determined to have end stage renal disease receiving home dialysis may choose to receive monthly end stage renal disease-related clinical assessments furnished on or after January 1, 2019, via telehealth. This provision allows freestanding dialysis facilities and the patient’s home to serve as the originating site and eliminates geographic restrictions for all originating sites. Patients will be required to receive a face-to-face visit for the first three months of home dialysis and once every three months thereafter. In certain circumstances, providers will be allowed to furnish equipment to help facilitate telehealth to patients receiving home dialysis.
SEC. 51006. RECOGNITION OF ATTENDING PHYSICIAN ASSISTANTS AS ATTENDING PHYSICIANS TO SERVE HOSPICE PATIENTS
This enables attending physician assistants to be recognized as attending physicians to serve hospice patients effective for services furnished on or after January 1, 2019.
Physician assistants (PAs) will be able to act in the same manner as nurse practitioners (NPs) for hospice patients. Since PAs, like NPs, may serve as a hospice patient’s attending physician, Medicare Part B can be billed for their services. However, this does not change the law that only a physician may certify that a patient has a terminal illness.
NAHC suggested that further information will come in the Federal Register 2019 payment update notice for transmittals later this year.
SEC. 53109. HOSPITAL TRANSFER POLICY FOR EARLY DISCHARGES TO HOSPICE CARE
Patients discharged early from hospitals to hospice will now result in a reduced reimbursement to the hospital. NAHC stated that applying a transfer payment policy for early discharges from hospitals to hospice care will save Medicare $500 million. This will apply to immediate referrals to hospice as well as those within a designated number of days. There is concern that this could result in delayed referrals to hospice for patients in need of hospice care. This rule has no impact on inpatient hospice payment.
How HEALTHCAREfirst Can Help
HEALTHCAREfirst will continue to monitor updates regarding the Bipartisan Budget Act of 2018 and will update this blog post with new information as it happens. Our customers can rest assured that we are on top of these changes.
Concerned about compliance with the Bipartisan Budget Act of 2018 and potential reimbursement changes? HEALTHCAREfirst has a strong track record of ensuring our customers stay ahead of the regulatory game while maximizing their reimbursements. Contact us today to learn how we can help your agency succeed now and in the future.