Trump Administration Delivers on Promise to Strengthen Medicare with a New Home Infusion Therapy Benefit and Home Health Regulations that Put Patients Over Paperwork
New Home Health Prospective Payment System responds to unique needs of patients and reduces burden on providers.
Today, consistent with the direction of President Trump’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors, the Centers for Medicare & Medicaid Services (CMS) finalized significant changes to the Home Health Prospective Payment System (HH PPS), including a new home infusion therapy benefit that builds on the historic steps we have already taken to strengthen and protect the Medicare program by increasing choices and empowering patients. The final rule with comment period implements the Executive Order by eliminating burdensome requirements of the Medicare program that are more stringent than applicable Federal or State laws for maintenance therapy. The final rule with comment period also increases Medicare payments to home health agencies (HHAs) by an estimated 1.3 percent ($250 million) for calendar year (CY) 2020.
“The Trump Administration is committed to bold and comprehensive healthcare policies that respond to the individual needs of patients. The new permanent home infusion therapy benefit increases the availability of home based care, by giving patients the choice and convenience to receive critical treatments, such as anti-infectives and chemotherapy, safely at home instead of a hospital or doctor’s office,” said CMS Administrator Seema Verma. “Today’s final rule also rewards value over volume by focusing on patient information such as their diagnosis and other health conditions, to more accurately pay for home health services.”
Today’s final rule with comment period will provide a permanent home infusion therapy benefit to be implemented beginning in 2021, as required by the 21st Century Cures Act. Home infusion therapy is the administration of certain types of medication, through a durable medical equipment (DME) pump, in the patient’s home. The home infusion therapy benefit includes: professional services, including nursing; patient education and training; and patient monitoring for the provision of home infusion therapy. In response to public feedback, CMS is also soliciting comments on options to enhance future efforts to improve policies related to coverage of eligible drugs for home infusion therapy.
In response to public feedback received under our Patients Over Paperwork initiative and as part of the Executive Order and the Trump Administration’s efforts to cut the red tape, CMS is modifying its regulations to allow therapist assistants—rather than only therapists—to perform maintenance therapy under the Medicare home health benefit, in accordance with individual state practice requirements. This change allows therapist assistants to utilize all of the skills under their license and gives HHAs the opportunity to use both therapists and therapist assistants to perform maintenance therapy. This ensures that HHAs have enough staff available to provide the appropriate amount of therapy to their patients, improving beneficiary access to these services.
CMS is implementing the Patient-Driven Groupings Model (PDGM), a new case-mix payment methodology for home health services, which more accurately pays for home health services and focuses on patient needs by relying heavily on patient characteristics rather than volume of care. CMS is finalizing a CY 2020 30-day payment amount for those HHAs that report the required quality data of $1,864.03, which is 4 percent higher than the proposed CY 2020 30-day payment amount of $1,791.73 as a result of a modification to our proposed adjustment, for the initial year of the PDGM, that is associated with behavior change assumptions.
CMS is addressing potential Medicare fraud by phasing out pre-payments for home health services over the next year and eliminating those payments completely in 2021.CMS has seen a marked increase in Request for Anticipated Payment (RAP) fraud schemes perpetuated by existing HHAs that receive significant upfront payments, then never submit final claims and close for business, making Medicare recoupment efforts impossible. CMS believes that eliminating RAP payments over the next two years would serve to mitigate potential fraud schemes while minimally impacting HHAs due to implementation of the PDGM, which increases the frequency of payments for services to HHAs.
The final rule with comment period can be downloaded from the Federal Register at: https://www.federalregister.gov/documents/2019/11/08/2019-24026/medicare-and-medicaid-programs-cy-2020-home-health-prospective-payment-system-rate-update-home
For a fact sheet on today’s final rule with comment period, please visit: https://www.cms.gov/newsroom/fact-sheets/cms-finalizes-calendar-year-2020-payment-and-policy-changes-home-health-agencies-and-calendar-year
For additional information about the Home Health Prospective Payment System, visit https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/index.html and https://www.cms.gov/center/provider-Type/home-Health-Agency-HHA-Center.html.
For additional information about the Home Health Patient-Driven Groupings Model, visit https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/HH-PDGM.html
For additional information about the Home Infusion Therapy benefit, visit - https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Home-Infusion-Therapy/Overview.html
For additional information about the Home Health Quality Reporting Program, visit https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Reporting-Requirements.html
For additional information about the Home Health Value-Based Purchasing (HHVBP) Model, visit: https://innovation.cms.gov/initiatives/home-health-value-based-purchasing-model
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