Aggregate Medicare home health prospective payment system (HH PPS) payments in calendar year (CY) 2020 will increase by 1.3%, or $250 million, compared to 2019 levels, under the Centers for Medicare & Medicaid Services’ (CMS) final CY 2020 rule. In addition to updating home health agency (HHA) policies, the final rule establishes a permanent home infusion therapy benefit that begins in CY 2021.
With regard to HH PPS payments, the rule finalizes a 1.5% payment update percentage, which is offset by a -0.2% rural add-on adjustment. In conjunction with implementation on January 1, 2020 of a new case mix methodology, the “Patient-Driven Groupings Model,” CMS had proposed an -8.01% budget neutrality adjustment in anticipation of expected “behavior changes,” such as modifications to documentation and coding practices. Based on comments and additional analysis, CMS instead finalizes a -4.36% behavior change adjustment. The final CY 2020 30-day payment rate for an HHA that submits required quality data is $1,864.03, up from the proposed rate of $1,791.73.
Other HHA policy changes CMS adopts in the final rule include: streamlined home health plan of care content requirements; authorization for physical therapy assistants to furnish maintenance therapy; modification of the split percentage payment policy (with elimination of split-percentage payments beginning in CY 2021); and updates to Home Health Quality Reporting Program and Home Health Value-Based Purchasing Model requirements.
The rule also finalizes transitional home infusion therapy rates for CY 2020 and establishes eligibility and payment policies for the permanent home infusion therapy benefit that begins in CY 2021. In response to stakeholder concerns regarding local Medicare policies that limit coverage of infused drugs, CMS requests comments on the criteria it could consider, within the scope of the durable medical equipment benefit, to allow coverage of additional home infusion drugs. The deadline for comments on this topic is December 30, 2019.