CMS-1625-F

The Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1625-F) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2016. In the CY 2016 final rule, CMS implements the third year of the four year phase-in of the rebasing adjustments to the HH PPS payment rates as required by the Affordable Care Act. In addition, CMS will decrease the national, standardized 60-day episode payment amount by 0.97 percent in each year for CY 2016, CY 2017, and CY 2018 to account for nominal case-mix growth between CY 2012 and CY 2014. CMS also provides an update to the Home Health Quality Reporting Program. Lastly, CMS is implementing a Home Health Value-Based Purchasing (HHVBP) model effective for CY 2016. CMS estimates that the net impact of the payment provisions of the final rule will result in a decrease of 1.4 percent ($260 million) in Medicare payments to HHAs for CY 2016. Along with the payment update, CMS is revising the ICD-10-CM translation list and adding certain initial encounter codes to the HH PPS Grouper based upon revised ICD-10-CM coding guidance.