CMS Proposes Payment Updates and Quality Reporting Changes for Home Health Agencies

July 13, 2018 | Aging Services Risk, Quality, & Safety Guidance

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​The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule with changes for home health agencies and home infusion therapy suppliers, according to a CMS fact sheet and news release issued July 2, 2018. It proposes changes to the "case-mix adjustment methodology" for its Home Health Prospective Payment System, focusing on care needed for patient's condition versus the amount of care provided for determining Medicare reimbursement. CMS projects a 2.1% increase in payments ($400 million) made to home health agencies in 2019. In addition, under the Bipartisan Budget Act of 2018, the unit of payment under the home health payment system would change from 60-day to 30-day periods of care, beginning January 1, 2020. In the same year, CMS proposes to cease using the number of home infusion therapy visits to determine payment and will instead use a Patient-Driven Groupings Model (PDGM) that aims to use patient characteristics to place periods of care into "meaningful payment categories," which would also support CMS's value-over-volume initiative. CMS continues implementation of the Home Health Value-Based Purchasing Model and the Home Health Quality Reporting Program (HH QRP).

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