Home Health PPS Proposed Rule for 2013

OASIS Changes for ICD-10.

CMS issued the CY2013 proposed rule last Friday. HHAs will be glad to know that CMS did not include in their proposal the co-pay that MedPAC recommended earlier this year. One item also not included that software vendors in particular have been on the lookout for is the expected changes to OASIS necessary for ICD-10.  ICD-10 is currently under proposal to be delayed until October 1, 2014 and Pat Sevast of CMS reported earlier this year that CMS would propose a rule with changes to the OASIS, to be known as OASIS C-1.

Below is a summary of changes included in the proposed rule. I will host an in-depth webinar on August 9th on the below items.


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.

NOTE: The Hospice rate changes for 10/1/12-9/30/13 were not included in the Proposed rule. Theresa Foster, NAHC’s Vice President for Hospice Policy & Programs, recently shared that the payment notice is currently at OMB under review and will be published by Aug. 1.

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

2012 Base Rate / Rural Base Rate2013 Base Rate / Rural Base Rate
$2138.58 / $2202.68$2141.95 / $2206.21



*As in prior years, agencies that do not submit quality data will have these rates reduced by 2%

Discipline2012 Non-Rural / Rural2013 Non-Rural / Rural
HHA$51.13 / $52.66$51.90 / $52.66
MSS$180.96 / $186.39$183.67 / $189.18
OT$124.96 / $127.99$126.12 / $129.90
PT$123.43 / $127.13$125.28 / $129.04
SN$112.88 / $116.27$114.57 / $118.01
SLP$134.12 / $138.14$136.13 / $140.21

*As in prior years, agencies that do not submit quality data will have these rates reduced by 2%

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.

The current location of the proposed rule is located here. This link will be updated once the proposed rule is published in the Federal register which is currently scheduled for July 13, 2012. HEALTHCAREfirst will revise the link location in the blog at that time.

CMS will accept comments on the proposed rule until September 4, 2012.