Agencies can breathe a deep sigh of relief. CMS won’t launch its drastically revised home health payment model after all.
In the 2018 final PPS rule released Nov. 1, CMS announced that it would not launch the Home Health Groupings Model (HHGM) in 2019.
“We are not finalizing the implementation of the HHGM in this final rule,” CMS said in the rule. “We received many comments from the public that we would like to take into further consideration.”
If the model had been released as proposed — “in a non-budget neutral manner” — it would have created $950 million in cuts to home health come 2019.
But it’s not all good news for home health. While the HHGM didn’t come together in the final rule, CMS did finalize its plan to move forward with an $80 million payment decrease in 2018.
The decrease will occur due to a 0.5% reduction in payments “due to the sunset of the rural add-on provision,” a 1% home health payment update percentage and a 0.9% drop in payments to account for nominal case-mix growth, CMS says.
By comparison, the 2017 PPS final rule included a $130 million payment reduction — 0.7%.
What spurred CMS’ HHGM decision?
More than 1,300 industry stakeholders commented on the proposed rule. That’s about 16 times as many comments CMS received for last year’s proposed rule.
CMS notes the commenters generally supported revising the PPS case-mix methodology to better align payments with the costs of providing care.
However, CMS said, “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.”
The commenters also want greater involvement in developing the HHGM “and the need for access to the necessary data in order to replicate and model the effects on their businesses.”
CMS says it will take time to further engage stakeholders as it moves toward a system that shifts to a more patient-centered model.
“CMS will take the comments submitted on the proposed rule into further consideration regarding patients’ needs that strikes the right balance in putting patients first,” the federal Medicare agency says in a fact sheet about the rule. The last major change to the payment system occurred in 2008, when CMS introduced a four-equation model into the way it calculates home health episode payments.
In addition to payment changes, the final rule also tweaks value-based purchasing.
CMS is removing from value-based purchasing the OASIS-based measure Drug Education on All Medications Provided to Patient/Caregiver During All Episodes of Care. And it’s increasing the minimum threshold for home health agencies — from 20 completed HHCAHPS surveys to 40 completed surveys.