CMS Proposes Home Health PPS Rate Cut for 2012
CMS published a proposed rule on July 12, 2011 that would decrease Medicare home health agency (HHA) PPS payments for CY 2012 by 3.35%, or $640 million, compared to 2011 levels. This reimbursement cut would reflect a 2.5% market basket update that is reduced by 1 percentage point as mandated by the ACA, a 0.1% wage index increase, and a 5.06% reduction to account for increases in aggregate case-mix that are unrelated to changes in the patient’s health status. In addition, if an HHA does not submit required quality data, the home health market basket percentage increase would be reduced by an additional 2 percentage points. The rule also would make a number of case-mix changes, including removing two hypertension codes from the case-mix system, lowering payments for high-therapy episodes, and recalibrating case-mix weights. The rule also addresses a number of home health policy issues. For instance, the rule would allow physicians who attend to a home health patient in an acute or post-acute setting to inform the certifying physician of their encounters with the patient in order to satisfy the requirement that a certifying physician or an allowed non-physician practitioner (NPP) has see a patient prior to certifying a patient as eligible for the home health benefit. CMS also proposes to clarify its ‘‘confined to the home’’ definition and certain occupational therapy policies. Comments on the proposed rule will be accepted until September 6, 2011.
