Proposed 2016 PPS rule at a glance
Effective Jul 7, 2015
Published Jul 7, 2015
Last Reviewed Jul 7, 2015
The HHL team has compiled this quick-reference tool to help you evaluate the major provisions of CMS’ proposed rule. The following changes would take effect in 2016 if the rule is finalized as proposed.
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Provision
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Content
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Section
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Payment
update
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CMS estimates to a $350 million payment decrease in estimated Medicare payments in 2016. That decrease reflects a 2.3% increase in payments offset by a proposed reduction to the national, standardized 60-day episode payment rate in 2016 — “to account for nominal case-mix growth” — and the third year of the four-year phase-in of the rebasing adjustments as required by the Affordable Care Act.
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III. C. 1.
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Home health value-based purchasing model
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CMS plans to create a value-based purchasing model to be tested in nine states. Agencies that meet or exceed performance standards would be eligible for bonuses.
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IV.
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Rate-setting changes
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Core Based Statistical Area (CBSA) changes affect the home health wage index. In the 2015 PPS rule, a blended wage index was calculated as 50% of the CY 2015 wage index using current Office of Management and Budget (OMB) delineations and 50% of the CY 2015 wage index using revised OMB delineations. The proposed 2016 PPS rule CMS seeks to fully transition to the new CBSA designations.
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III. C. 2.
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OASIS update
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CMS proposes establishing a minimum threshold for submission of OASIS assessments for purposes of quality reporting compliance.
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III. V.
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Case-mix weights
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CMS is recalibrating the home health PPS case-mix weights, using the most current cost and utilization data available, in a budget-neutral manner.
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III.B.1
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Skin integrity quality measure
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CMS proposes a new quality measure that addresses the domain of skin integrity and changes in skin integrity. The IMPACT Act requires the specification of such a quality measure by Jan. 1, 2017.
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V. C.
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Source: Proposed 2016 PPS rule
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