CMS Finalizes PPS Final Rule, Holds Off on Implementation of HHGM
Wednesday, November 1, 2017
Posted by: Kyle Simon
The CY 2018 Home Health Prospective Payment System (HH PPS) final rule was announced moments ago by the Centers for Medicare & Medicaid Services (CMS).
The final rule updates the HH PPS payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply conversion factor, effective for home health episodes of care ending on or after January 1, 2018.
This rule also:
- Updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking;
- Implements the third year of a three-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between calendar year 2012 and CY 2014; and,
- Discusses CMS's efforts to monitor the potential impacts of the rebasing adjustments that were implemented in CY 2014 through CY 2017.
In addition, this rule finalizes changes to the Home Health Value-Based Purchasing Model and to the Home Health Quality Reporting Program.
Additionally, we are excited to report that CMS announced CMS will not be finalizing the implementation of the Home Health Groupings Model (HHGM) in this final rule! This is not the full equivalent of withdrawing the proposal, however, it is a clear victory for the industry that took all action to stop the rule from becoming final.
The final rule states:
We received many comments from the public that we would like to take into further consideration. While commenters were generally supportive of the concept of revising the HH PPS case-mix methodology to better align payments with the costs of providing care, commenters included technical comments on various aspects of the proposed case-mix adjustment methodology under the HHGM and were most concerned about the proposed change in the unit of payment from 60 days to 30 days and such change being proposed for implementation in a non-budget neutral manner. Commenters also stated their desire for greater involvement in the development of the HHGM and the need for access to the necessary data in order to replicate and model the effects on their businesses.
After months of advocacy and countless meetings with policy makers in the Trump Administration and Congress, this is a significant victory for our industry, and it could not have been realized without your efforts! Of the more than 1,300 comments submitted to CMS, more than a third came from Florida. As a result, patients and providers are spared what would amount to barriers to access to care and a massive reimbursement cut that would decimate too many honest and quality agencies.
Click here to read the final rule. A more detailed analysis will be made available as soon as possible. In the meantime, please click here to say thank you to the 174 members of the U.S. House of Representatives who stood in solidarity with our industry to stop HHGM from being implemented.