CMS1230142

The Centers for Medicare & Medicaid Services (CMS) issued a final rule to update the Medicare Home Health ospective Payment (HH PPS) rates for calendar year (CY) 2010. This final 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), updates the HH PPS rates by a 2.0 percent home health market basket update, and as part of efforts to address potential fraud and abuse regarding outlier payments to home health agencies revises its outlier policy (for CY 2010) by capping outlier payments at 10 percent of total HH PPS payments, updating the fixed dollar loss ratio to 0.67, and targeting outlier payments to be no more than 2.5 percent of total HH PPS payments (returning 2.5 percent back into the base rate). CMS will also require the submission of OASIS as a condition for payment, and is implementing a new version of OASIS, OASIS-C, beginning January 1, 2010. CMS is also adding payment safeguards to improve the enrollment process, improve quality of care, and reduce fraud.