CMS1224701

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update the Medicare Home Health Prospective Payment (HH PPS) rates for calendar year (CY) 2010. This proposed rule continues with the previously promulgated 2.75 percent reduction to the HH PPS rates in CY 2010 (to account for the increase in case-mix not due to the underlying condition of the home health patient), proposes to update the HH PPS rates by a 2.2 percent home health market basket update, and as part of efforts to address potential fraud and abuse regarding outlier payments to home health agencies proposes to cap outlier payments at 10% of total HH PPS payments, update the fixed dollar loss ratio to 0..67, and target outlier payments to be no more than 2.5 percent of total HH PPS payments (returning 2.5% back into the base rate). CMS is also proposing to require the submission of OASIS as a condition for payment, as well as adding payment safeguards to improve the enrollment process, improve quality of care, and reduce fraud. Finally, CMS is also proposing to implement a new version of OASIS, OASIS-C, on January 1, 2010.