Dive Brief:
- CMS issued a proposed rule late Monday that could cut 2017 Medicare rates for home health agencies (HHA) by 1%, or $180 million.
- Next year is slated to be the last of four years in which cuts were introduced in an effort by the agency to recoup overpayments made in previous years. The previous cuts were $260 million for 2016, $60 million for 2015 and $200 million for 2014.
- CMS reported 3.4 million beneficiaries received home health services from about 11,400 HHAs in 2015 at a cost to Medicare of $17.8 billion.
Dive Insight:
The reduced margins for home health agencies may be responsible for some leaving the program; while in 2014 there were a reported 11,781 HHAs serving Medicare beneficiaries, CMS' estimate was down to 11,400 for 2015, Modern Healthcare noted, adding the drop may also be a result of moratoria on new providers in fraud hot spots.
In other updates, the rule also proposes to update the HH PPS payment rates by the home health payment update percentage of 2.3%, as required by the Social Security Act.
It also proposes the adoption of four measures for the 2018 payment determination to meet the requirements of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014:
- All-condition risk-adjusted potentially preventable hospital readmission rates;
- Total estimated Medicare spending per beneficiary;
- Discharge to the community; and
- Medication reconciliation.
Monday's rule added information regarding the home health value-based purchasing model finalized in the 2016 Home Health Prospective Payment System rule. Under the pilot, all Medicare-certified home health agencies providing services in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington will have their payments adjusted up or down each year depending on their performance measures. The HHAs will see a maximum payment adjustment of 3% in 2018, 5% in 2019, 6% in 2020, 7% in 2021, and 8% in 2022.