The proposed PPS rule for home health is generally released in late June or early July, but that’s not the case this year — and there’s no clear indication about when the rule is coming.
 
The 2018 proposed rule hasn’t appeared on the Federal Register for public view, and CMS officials would not comment to agencies during a July 20 open door forum when asked about when the rule would be released. The rule was received in April for review by the Office of Management and Budget; clearing OMB is the last step before it’s released on the Federal Register for public view.
 
The last time the proposed rule took this long to be released was 2009, when it appeared July 30, says Bill Dombi, vice president of law of the National Association for Home Care and Hospice (NAHC).
 
Since then, the longest agencies have had to wait for the rule’s release was July 16 — until now, he says.
 
Last year, the proposed rule was released June 27.
 
NAHC is unsure why there’s a delay
 
One possibility for why the rule is taking so long to be released in 2017, Dombi says, is that this year’s version isn’t controversial at all and that CMS’ attention has been elsewhere.
 
Seema Verma, the administrator for CMS, has been working on changes to the Affordable Care Act.
 
But perhaps in the proposed rule CMS had planned on including something highly controversial for the industry — drastically revising the home health payment model for next year — and has since decided against doing so, he speculates.
 
According to CMS contractor Abt Associates, the Home Health Groupings Model (HHGM) would have 128 possible payment groups, a reduction of 25 from the current system. And unlike the current system, the groupings model wouldn’t rely on the number of therapy visits performed to influence payment.
 
It’s possible that instead of changing the existing payment system to the HHGM next year, CMS instead will seek input about HHGM and make no immediate change, Dombi speculatesreasons.
 
Read more about the HHGM at http://go.cms.gov/2tNCIQZ.
 
PPS rule’s release could still take a while
 
CMS’ proposed rule, Dombi says, requires a 60-day comment period. And the final rule must be released at least 60 days before it takes effect.
 
With a Jan. 1, 2018, effective date for the PPS rule, that would mean “a drop dead date” of Nov. 2 or 3, 2016, for the final rule’s release, Dombi says.
 
So the proposed PPS rule can be released as late as Sept. 3, 2017, if CMS can handle a turnaround of releasing a final PPS rule just one day after the comment period ends.
 
“Obviously, the one-day turnaround is not realistic,” Dombi says. “If CMS plans to use a 30-day turnaround, a publication of the proposed rule on Aug. 3 is an option. The longer it takes, the less time CMS has to compose and clear a final rule.”