CMS Updates Home Health Payments for 2011

The Centers for Medicare & Medicaid Services (CMS) filed with the Office of the Federal Register (OFR), Nov. 2, a final rule to update the Home Health Prospective Payment System (HH PPS) for 2011 and implement various Affordable Care Act (ACA) provisions, effective Jan. 1, 2011.

The impact of the ACA provisions, wage index and market basket updates, and case-mix coding adjustments are expected to decrease home health agency (HHA) payments by approximately $960 million, or 4.89 percent, in 2011.

Under the new health reform law, the existing HHA outlier cap becomes permanent and HH PPS rates are reduced by 2.5 percent. The law also requires CMS to apply a 1 percentage point reduction to the 2011 HH market basket amount for a 1.1 percent market basket update.

Another ACA provision requires physicians certifying patients’ eligibility for Medicare’s HHA benefit to document face-to-face encounters. CMS finalizes this provision in the final rule, with revisions.

Also in the final rule, CMS establishes an exception to the 36-month ownership provision, which CMS just created this year. The policy that requires HHAs that change ownership within three years of initial enrollment to obtain a new state survey or accreditation. HHAs that submitted two consecutive years of full cost reports are exempt. For purposes of this exception, however, low utilization or no utilization cost reports do not qualify as full cost reports.

The rule will be published at the Federal Register Nov. 29.

Source: CMS press release, issued Nov. 3


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