The home health industry received a surprise third reprieve from payment cuts expected in 2025 with a 0.5% aggregate pay increase set in the Home Health Prospective Payment System final rule released late Friday, Nov. 1.
In the rule, CMS also finalized new questions for the OASIS starting in 2027 and a new requirement for the Conditions of Participation (CoPs).
The national payment rate increase comes after a proposed cut of 1.70% in June, which included a 3.95% payment cut to account for industry behavioral changes under PDGM. As in 2023 and 2024, CMS will only take half that amount, or 1.80%. A market basket update to account for rising costs pushed the national rate to positive territory.
The actual rate for an agency will depend on local wage adjustments in a U.S. Census designated area and may be higher or lower than the national rate.
The reduced payment cut might mean temporary relief for some agencies, but CMS is only delaying the collection of the other half of this payment cut. It will have to come with future cuts that CMS has yet to determine.
Effective Jan. 1, 2025, there will be a new item among the CoPs, requiring agencies to develop, implement and maintain an acceptance to service policy.
At minimum, the agency’s policy would need to address the following items related to the agency’s capacity to provide patient care: anticipated needs of the referred prospective patient, the agency’s case load and case mix, agency staffing levels and the skills and competencies of the agency staff.
Experts note that many agencies already have policies like the new requirement, though the change may require more documentation around considerations when weighing a referral.
Agencies will also need to make information available to the public about types of specialty services, service duration and service frequency to make it easier for patients and caregivers to select an appropriate agency and avoid delays in care.
Additional SDoH questions
CMS finalized new Social Determinants of Health (SDoH) questions that will be added to the OASIS-E in 2027. They include four new questions around housing, food and utilities, along with a modified version of the existing transportation question.
- What is your living situation today?
- Within the past 12 months, you worried that your food would run out before you got money to buy more. Often true, sometimes true or never true.
- Within the past 12 months, the food you bought just didn’t last and you didn’t have money to get more. Often true, sometimes true or never true.
- In the past 12 months, has the electric, gas, oil or water company threatened to shut off services in your home?
- (Updated) In the past 12 months, has lack of reliable transportation kept you from medical appointments, meetings, work or from getting things needed for daily living?
Officials noted in the proposed rule that the responses to these items may affect treatment approaches and goals for the patient and allow for an opportunity for the agency to connect that patient and caregivers to local resources.