Home health agencies get less than a 1% payment increase
CMS had originally proposed a 2.2% decrease to account for the permanent behavior assumption adjustment.
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Home health agencies get a 0.8% pay increase for 2024 rather than a proposed 2.2% decrease, under the Home Health Prospective Payment System Final Rule released by the Centers for Medicare and Medicaid Services on Wednesday.
CMS estimates that Medicare payments to home health agencies will increase by about $140 million in 2024, compared to 2023.
The finalized payment reflects a 3% home health payment update percentage, an estimated 2.6% decrease from the net effects of the finalized prospective permanent behavior assumption adjustment, and an estimated 0.4% increase due to an update to the fixed-dollar loss ratio used in determining outlier payments.
But a finalized -2.890% permanent adjustment is half the full permanent adjustment of -5.779% in the proposed rule issued in June. This halving of the permanent adjustment is in response to commenter concerns about the magnitude of a single-year significant payment reduction, CMS said.
For 2023, CMS finalized implementing half (-3.925%) of the permanent adjustment estimated at the time (-7.85%).
CMS said it would have to account for the remaining permanent adjustment not applied in 2024 and other potential adjustments needed to the base payment rate, to account for behavior change based on analysis at the time of future rulemaking.
WHY THIS MATTERS
For 2024, CMS had proposed home health agencies get a 2.2% payment decrease compared to 2023 because of a permanent behavior assumption adjustment.
The slight 0.8% payment increase for 2024 won't decrease payments as proposed. For 2024, CMS is adopting a 2021-based home health market basket, which includes proposed changes to the market basket cost weights and price proxies.
HOME HEALTH AIDE SERVICES
Solicited comments from the proposed rule on home health aide services has resulted in the final rule including a discussion on the comments received. CMS said the feedback will help guide policy formulation processes to assist in refining policy development, address barriers and foster coordination under the home health benefit for future regulatory updates.
HOSPICE
In addition, the final rule includes several enrollment provisions that apply to hospices as well as other provider types.
CMS said it believes these provisions will help protect hospice beneficiaries by more closely scrutinizing prospective hospice owners and ensuring that newly enrolled hospices provide appropriate care to people nearing the end of life.
The final rule also includes a new informal dispute resolution (IDR) process for hospice programs and a special focus program to enhance oversight of the poorest-performing hospices, building on similar oversight and enforcement programs focused on nursing homes.
CMS is also finalizing several provider enrollment regulatory changes to prevent and address hospice fraud, waste and abuse. CMS believes these provider enrollment provisions related to hospice ownership and management will both strengthen protections against hospice fraud schemes and improve transparency.
The hospice enrollment-related regulatory changes in this final rule include:
- Subjecting hospices to the highest level of provider-enrollment application screening, which includes fingerprinting all 5% or greater owners of hospices.
- Expanding the change in majority-ownership provisions;
- Clarifying that the definition of "Managing Employee" to include the administrator and medical director of a hospice.
CMS is finalizing the details of the special focus program (SFP) provisions for 2024 to increase regulatory oversight for poorly performing hospices.
Previous public comments urged CMS first to convene a Technical Expert Panel (TEP). One was convened in 2022. CMS is finalizing the methodology and an algorithm with criteria for identifying hospices that should be in the SFP based on the recommendations and other stakeholder feedback.
Hospice programs that are unable to resolve the deficiencies that brought them into the special focus program and cannot meet the completion criteria would be placed on a termination track.
The Hospice Informal Dispute Resolution program would allow hospice providers an informal opportunity to refute one or more condition-level deficiencies cited in the Statement of Deficiencies survey report.
HEALTH EQUITY
CMS is including an update on health equity to let stakeholders know it is committed to developing approaches to meaningfully incorporate the advancement of health equity into the expanded home health value-based program model.
CMS said it is continuing to take input from home health stakeholders and monitor the application of proposed health equity policies across CMS initiatives, such as proposed payment adjustments in the Hospital and SNF Value-Based Purchasing Programs.
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org
