CMS estimates that 2025 home health payments will decrease in the aggregate by 1.7%, or a $280 million reduction in payments compared to 2024.
That figure was part of CMS’ payment projection in the 2025 proposed rule for the Home Health Prospective Payment System Rate Update released on Wednesday, June 26, 2024.
The reduction in payments includes a permanent 3.6% cut in the national, standardized 30-day period payments as part of behavioral adjustments under PDGM, amounting to a $595 million decrease. It is offset partially by a 2.5% increase in the home health payment update percentage.
As reported at Home Health Line ahead of the rule’s release, CMS is proposing to add four new assessment items and a modified question to the OASIS looking at Social Determinants of Health (SDoH), beginning in 2027.
The rule also would add a new CMS standard in the Conditions of Participation requiring agencies to develop, consistently apply and maintain an acceptance to service policy, including specific factors that would govern the process for accepting patients to service. CMS would also require agencies to make specified information about their services and service limitations available to the public.
CMS is also looking for feedback on shifting its longstanding policy and permitting rehabilitative therapists to conduct the initial and comprehensive assessment for cases that have both therapy and nursing services ordered as part of the plan of care.
The proposed rule is scheduled to be published July 3, 2024. Comments are due by Aug. 26, 2024.
SDOH items
If finalized, new SDOH measures will be added to the OASIS in 2027 to collect data on living situation, food and utilities, along with an updated question on transportation.
The proposed questions include whether the patient has a steady place to live, has worried about running out of food or actually ran out of food, has risked getting utilities shut off and has unreliable transportation.
Change to CoPs
A new standard that would be added at §484.105 would require agencies to develop a service policy that, at a minimum, would address the agency’s capacity to provide patient care. Including:
The anticipated needs of the referred prospective patient
The agency’s case load and case mix
The agency’s staffing levels
The skills and competencies of agency staff
Agencies would also be expected to publicly report the services offered by the agency and any limitations related to the types of specialty services, service duration or service frequency. This information would need to be reviewed annually or as necessary, CMS states.
The goal of this change, according to CMS, is “to improve the referral process and reduce avoidable care delays by helping to ensure that referring entities and patients can select the most appropriate agency based on their care needs and to make this information available to the public."
Look for more coverage on the proposed rule in an upcoming issue of Home Health Line.