The 2018 Home Health Prospective Payment System (HH PPS) Final Rule was recently posted, with no significant payment changes for the coming year. As noted in a November 2 blog post, the Home Health Groupings Model (HHGM) proposed for 2019, which would have significantly changed reimbursement calculations for home health agencies, was removed until further industry input reviewed by the Centers for Medicare and Medicaid Services (CMS).
Beginning in 2015, CMS made the decision to adjust the home health industry’s annual payment rate recalibrations in a budget-neutral manner using the most current cost and utilization data available. In 2018, the upcoming national, standardized 60-day episode payment rates will be increased by one percent as mandated by the Medicare Access and CHIP Reauthorization Act of 2015. However, this rate will be reduced by the third and final 0.97 percent adjustment for “case-mix creep,” which CMS describes as estimated case mix growth from 2012 through 2014 that was unrelated to increases in patient acuity.
There is also a 0.5 percent reduction due to the sunset of the rural payment add-on. The fixed-dollar loss ratio remains 0.55 in 2018, to pay up to but no more than 2.5 percent of total payments as outliers. In summary, the 2018 rule decreases net home health payments by 0.4 percent, or $80 million compared with 2017.
Additional changes include amending the Home Health Value-Based Purchasing Model (HHVBP) definition of “applicable measure.” Applicable measure, for performance year one and forward, will now mean a measure for which a competing home health agency has provided a minimum of 40 completed HHCAHPS surveys to receive a performance score based on HHCAHPS measures.
Also noteworthy is the OASIS-based measure Drug Education on All Medications Provided to Patient/Caregiver during All Episodes of Care has been removed from the set of applicable measures in the third and subsequent performance years.
There are also several notable changes to the Home Health Quality Reporting Program (HHQRP). CMS is replacing one quality measure and adopting two new quality measures, and there are also changes to data submission requirements, exemption and extension requirements, and reconsideration and appeals procedures for the HHQRP.
Also finalized was a plan to remove 235 data elements from 33 current OASIS items, beginning with all home health agency assessments on or after January 1, 2019. This means that agencies should plan for coming OASIS item set changes and temporary loss of clinician productivity as they learn new OASIS data sets in 2019.
Overall, these changes are not highly disruptive, but rather are on schedule with the plans put forth in recent years focusing on high quality care, data-driven outcomes and QAPI programs, patient-centered care with population health and financial responsibility.
Axxess will continue to provide ongoing training for the changes to the HH PPS Final Rule with subsequent blog articles and on-demand training content. Our library of blogs and videos contains valuable educational resources. Check them out to learn more.
