CY 2025 Home Health Prospective System Final Rule
A correction notice to the CY 2025 Home Health Prospective System Final Rule is forthcoming. The CY 2025 final rule, which displayed at the Federal Register on November 1, 2024 included the wrong low comorbidity subgroup list; however, both the CY 2025 Final Low Comorbidity and High Comorbidity Adjustment Interactions (ZIP) file in the Downloads section and the Home Health PPS Grouper Software (HHGS) | CMS contain the correct low comorbidity subgroups. The rule contains policies which will be effective January 1, 2025.
We will update the HH PPS Center webpage once the correction notice has been issued.
Medicare Home Health Prospective Payment System (HH PPS) Calendar Year (CY) 2023 Behavior Change Recap, 60-Day Episode Construction Overview, and Payment Rate Development Webinar
On Wednesday March 29, 2023, CMS provided an overview of several provisions from the CY 2023 HH PPS final rule related to behavior changes, the construction of 60-day episodes, and payment rate development for CY 2023. View the webinar details for more information and materials.
December 27, 2022: CY 2023 Rural Add-on Policy
Section 4137 of the Consolidated Appropriations Act, 2023 extends the 1% rural add-on payment for home health periods and visits that end in CY 2023 for counties classified as ‘‘low population density.’’ CMS will increase the 30-day base payment rates by the 1% rural add-on before applying any case-mix and wage index adjustments. There are no changes to the fixed-dollar loss ratio, budget neutrality factors, or final base payment rates.
Report to Congress: Unified Payment for Medicare-Covered Post-Acute Care
Section 2(b)(2)(A) of the Improving Post-Acute Care Transformation (IMPACT) Act of 2014 requires a report to Congress (PDF) on unified payment for Medicare post-acute care (PAC). Medicare PAC services are provided to beneficiaries by PAC providers defined as skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), and home health agencies (HHAs). Each PAC provider setting has a separate Medicare fee-for-service (FFS) prospective payment system (PPS). A goal of unified PAC payment is to base the payment on patient characteristics instead of the PAC setting.
The Centers for Medicare and Medicaid Services (CMS) and the Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with Research Triangle Institute (RTI) to provide analysis for this study and report. RTI convened external technical expert panel meetings to obtain input on the study and report. In the report, the framework applies a uniform approach to case-mix adjustment across Medicare beneficiaries receiving PAC services for different types of PAC providers while accounting for factors independent of patient need that are important drivers of cost across PAC providers. The unified approach to case-mix adjustment includes standardized patient assessment data collected by the four PAC providers. The report does not include legislative recommendations, as additional analyses would need to be done prior to testing or universal implementation of a unified PAC payment system. See Unified PAC Report to Congress Appendices (ZIP).
Home Health, Hospice and DME Open Door Forum
For questions about home health payment policy, send your inquiry via email to: HomehealthPolicy@cms.hhs.gov.
