(Updated at 4:10pm on Nov. 5)
 
The final 2013 PPS rule for home health will decrease payments by only 0.01%, but includes new sanctions for CMS surveys and clarifications of the face-to-face encounter and therapy requirements. 
 
CMS also is finalizing its proposed changes to the diagnosis payment slot (M1024) with modifications to allow for the reporting of resolved conditions, but will restrict the awarding of points to fracture conditions.
 
Update: Coding experts estimate that the finalized version of the M1024 change still will result in significant case-mix point losses for agencies. This is due to the fact that only fracture conditions will allow agencies to score points, meaning conditions resolved through surgery would no longer qualify.
 
Other notable provisions of this final rule:
 
  • Face-to-face encounters: As proposed, CMS will allow non-physician practitioners (NPPs) to conduct encounters under the supervision of a treating physician when patients are coming to home health from an acute or post-acute facility. That facility physician will then inform the certifying physician.
     
  • Therapy reassessments: A controversial proposal to limit the allowed timeframe for assessments in multi-therapy cases to visits 11, 12 or 13 and 17, 18 or 19, respectively, has been finalized. However, CMS is giving agencies additional flexibility in cases where the scheduled frequency of disciplines is such that the assessment timeframes can’t be met without scheduling an unnecessary visit or delaying a visit. Update: In such cases, therapists can reassess on the visit closest to, but not after, the required ranges.
  • Alternative survey sanctions: CMS is finalizing its proposal to implement alternative sanctions, such as civil monetary penalties and payment suspensions, for agencies that don’t comply with the conditions of participation. However, CMS agrees to provide the industry an opportunity for feedback on interpretive guidance regarding the sanctions. Civil monetary penalties, suspension of payment for new admissions and an informal dispute resolution process will not take effect until July 1, 2014. All other survey-related provisions will take effect July 1, 2013.
Update: CMS says it will allow industry stakeholders to comment on interpretive guidance surrounding the sanctions. The federal agency also has softened one proposed sanction, which would have suspended payments for new admission and new episodes for affected agencies. Now, suspensions will only impact new admissions, meaning agencies will continue to receive payment to care for existing patients.
 
Editor’s note: The final rule is available at http://www.ofr.gov/OFRUpload/OFRData/2012-26904_PI.pdf.
 
 
Get operational tips to comply with the changes and to minimize the impact of the final 2013 PPS rule by registering for HHL’s webinar, 2013 PPS Final Rule: Get Smart Operational Strategies, at http://www.decisionhealth.com/conferences/A2323.