CMS-1747-P

CMS issued a proposed rule [CMS-1747-P] that proposes routine updates to the home health payment rates for calendar year (CY) 2022, in accordance with existing statutory and regulatory requirements. This rule also provides monitoring and analysis of the Patient-Driven Groupings Model (PDGM); solicits comments on a methodology for determining the difference between assumed versus actual behavior change on estimated aggregate expenditures for home health payments as result of the change in the unit of payment to 30 days and the implementation of the PDGM case-mix adjustment methodology; proposes to maintain the CY 2021 low utilization payment adjustment (LUPA) thresholds; and proposes to recalibrate the PDGM case-mix weights, functional levels, and comorbidity adjustment subgroups for CY 2022. Additionally, this rule proposes to utilize the physical therapy LUPA add-on factor to establish the occupational therapy add-on factor for the LUPA add-on payment amounts; and make conforming regulations text changes to reflect that allowed practitioners are able to establish and review the plan of care.