CMS Releases 2020 Medicare Home Health Payment Proposal

Sink your toes in the sand, slime on some sunscreen and start skimming! Just when you were looking for a good beach read, CMS released its 346-page CY2020 proposed payment rule for Medicare home health. As expected, the rule elaborates on the Patient-Driven Groupings Model and recommends changes to existing requirements, including quality measures and patient assessments. Comments on the rule are due by September 9th. The Alliance will work with NAHC to develop comments. Here are the plot highlights:

The HHPPS base rate will increase 1.5%, to $3,221.43. This will apply to 60-day episodes that begin prior to January 1, 2020. The latest the 60-day episode payment will cover is February 28th, 2020.PDGM methodology will apply to episodes that begin on January 1, 2020.

LUPA rates will increase 1.5% plus a 1.00065 adjustment for wage index budget neutrality. Rural add-on payments will phase down to .5% for Merrimack County and 2% for NH’s other rural counties.The 30-day payment base rate under PDGM will be $1791.73. The”behavioral adjustment” has been raised from a 6.42% cut to an 8.01% cut. The wage index for 2020 will be 1.0093 for NH’s rural counties, 0/9453 for Hillsborough County and 1.1052 for Rockingham & Strafford Counties. RAP will be phased out.

There will be no RAP in 2020 for any newly-certified agencies. RAP for current agencies will be reduced to 20% of the 30-day payment unit.CMS has proposed a home health Notice of Admission (NOA) within 5 days, similar to the hospice NOE. The penalty will be 1/30th of the 30-day payment for each day the NOE is late.

Home health quality reporting will transition to “standardized patient assessment data elements” (SPADE) as required by the IMPACT Act. This will result in major OASIS changes in 2021. There are also proposals related to maintenance therapy provided by PTAs and billing changes for certain home infusion therapies.

NAHC offered an excellent overview in webinar on July 18. The recording is free to any agency. Click here to access the NAHC webinar and handouts.