CMS to Publish Home Health and Hospice Rates & the Final Rule Soon

Home Health & Hospice Agencies Expect Relief.

The 2013 Medicare Home Health and Hospice Rates and final rule has been sent to the Office of Management and Budget (OMB). In order to meet the deadline of setting rates for January 1, 2013, CMS must publish the final rule 60 days before it’s effective date. Based on the 60 day requirement and past history of final rule submissions, industry proponents are expecting the rule to be published on either Friday October 26th or Friday November 2nd.

HEALTHCAREfirst will review the final rule once published and provide clients and members of the blog an opportunity to participate in a FREE Webinar to review how the changes will impact you. The webinar is tentatively set to occur on November 13, 2012.

Below are the items that were included in the proposed rule:


Quality Reporting

  • No expansion of collection requirements for CY2013 (which affects payments for FY2015) beyond those items being collected during the final calendar quarter of CY2012 (which affects payments for FY2014). The existing measures and data collection model timeframe can be located here.
  • CMS does not intend to move to public reporting of hospice quality indicators until it has developed a standardized data set for hospices.

Home Health

F2F “Relief”

  • Allow non-physician practitioners in an inpatient settings to perform the encounter and inform the certifying physician.
  • Allow the F2F document titling to be non-prescriptive to prevent inappropriate claim denials based solely on the document label.

Therapy Re-assessment “Relief”

  • In the case of a qualified therapist missing a reassessment visit, allow therapy coverage to resume with the visit during which the qualified therapist completes the late reassessment, instead of the visit after the therapist completes the late reassessment.
  • In the case where multiple therapy disciplines are involved and the required reassessment visit is missed by one of the therapy disciplines providing service but not the others, allow therapy coverage to continue for the therapies that did complete the re-assessment and only cease for the particular therapy discipline that did not complete timely.
  • Clarify that in cases where the patient is receiving more than one type of therapy, allow qualified therapists to complete their reassessment visits during the 11th, 12th, or 13th visit for the required 13th visit reassessment and the 17th, 18th, or 19th visit for the required 19th visit reassessment.

G-Code Title Correction

  • Make a technical correction to the terminology of G0158, replacing the word “therapist” with “therapy”.

Alternative Sanctions

  • Establish requirements for unannounced, standard, and extended surveys of home health agencies (HHAs) and provide a number of alternative (or intermediate) sanctions that could be imposed if HHAs were out of compliance with Federal requirements.

Payment Rates



A copy of the CY 2013 Home Health PPS Wage Index File can be located under the download links at the bottom of the following CMS page.