Legislative Update: November 12, 2019

Final Rule Published for Home Health Payment and Quality Reporting
On November 8, 2019, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2020 CY 2020 Home Health Final Rule detailing changes to Medicare payment and policy effective on January 1, 2020.  This final rule delivers on a number of statutory imperatives from the Bipartisan Budget Act of 2018. They include:

  1. Implementation of the Patient-Driven Groupings Model (PDGM) which is an alternate case-mix adjustment methodology with a 30-day unit of payment
  2. An aggregate Medicare payment increase to home health agencies (HHAs) in CY 2020 of 1.3%, or $250 million, which reflects the effects of the 1.5% home health payment update ($290 million increase) and a 0.2% aggregate decrease (-$40 million) in payments to HHAs due to the changes in the rural add-on percentages
  3. Rate updates also include an adjustment to the CY 2020 30-day payment amount to offset CMS’ assumptions of provider behavior changes upon implementation of the PDGM
The final rule did address concerns expressed by ElevatingHome & VNAA and LeadingAge about the negative impact of the proposed behavior assumption adjustments. The final rule reduces the adjustment down to -4.36% from -8.01% in the proposed rule.  ElevatingHome & VNAA had also expressed concern about phase out of Requests for Anticipated Payments. In the final rule, CMS reduces the split-percentage payment amount, paid in response to a RAP, to 20% for existing HHAs beginning in CY 2020 with elimination of split-percentage payments for all HHAs in CY 2021. For CY 2021, there will be no up-front payment made in response to a RAP; however, RAPs will still be submitted by all HHAs every 30 days to alert the claims processing system that a beneficiary is under a home health period of care. A summary of payment changes is here.
Changes to the Home Health Quality Reporting Program (HH QRP)
The Home Health Final Rule adds two new performance measures to the Home Health Quality Reporting Program and removes one measure. There are 19 measures currently adopted in the HH QRP. Measures adopted for the HH QRP are publicly reported on the Home Health Compare website.
As part of the requirement to implement a quality measure addressing the transfer of health information, CMS finalized adoption of two new measures required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act.
(1) Transfer of Health Information to Provider-Post-Acute Care - calculated as the proportion of quality episodes with a discharge/transfer assessment indicating that a current reconciled medication list was provided to the admitting provider at the time of discharge/transfer.
(2) Transfer of Health Information to Patient-Post-Acute Care - a process-based measure that assesses whether or not a current reconciled medication list was provided to the patient, family, and/or caregiver when the patient was discharged from a PAC setting to a private home/apartment, a board and care home, assisted living, a group home or transitional living.
CMS finalized removal of the Improvement in Pain Interfering with Activity Measure (NQF #0177) from the HH QRP.  CMS intends to mitigate any potential unintended, over-prescription of opioid medications inadvertently driven by this measure. In the final rule, CMS did address stakeholder feedback about the importance of monitoring pain in home health care settings and did not remove the question “In the last 2 months of care, did you and a home health provider from this agency talk about pain,” from the Home Health Care Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey.
CMS finalized adoption of a number of ‘standardized patient assessment data elements (SPADEs) for CY 2022 quality reporting.  These SPADEs assess cognitive function and mental status, special services, treatments and interventions, medical conditions and comorbidities, impairments, and social determinants of health (race and ethnicity, preferred language and interpreter services, health literacy, transportation, and social isolation).  CMS indicates that addition of these SPADEs to the Outcome and Assessment Information Set (OASIS) will improve coordination of care and facilitate communication between HHAs and other members of the healthcare community, which is in alignment with CMS’s strategic initiative to improve interoperability.
Finally, CMS is finalizing the update to the specifications for the Discharge to Community PAC HH QRP measure to exclude baseline nursing home residents.

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