CMS Final Rule Released: Home Health Prospective Payment System Rates and Value-Based Purchasing Program
October 30, 2015 02:50 PM
The Centers for Medicare & Medicaid Services (CMS) has released the final rule that includes the 2016 Home Health Prospective Payment System rate update and the Home Health Value-Based Purchasing (VBP) pilot program.
Following are the highlights:
The case mix creep adjustment has been reduced from the proposed level and will be phased in over 3 years.
The final case mix creep adjustment is 2.88% compared to the proposed 3.41%
It will be phased in with reductions of 0.97% in 2016, 2017, and 2018, instead of the proposed 1.72% in 2016 and 2017.
Rebasing will be as proposed with episode rates reduced by $80.95 along with adjustments to the LUPA rates and Non-routine Medical supplies.
The rates will be subject to the Productivity Adjustment of 0.4%.
The impact of the rate rebasing and adjustments is estimated at -$260 million.
VBP is on for 2016 with a 2015 baseline year on performance.
The same 9 states as proposed are included: MA, MD, NC, FL, WA, AZ, NE, and TN.
CMS dropped four process measures and one of the new reporting measures.
The biggest change is a shift to a 3-8% level of payment at risk beginning in 2018. CMS had proposed 5-8%. It will be phased in at 3% in 2018, 5% in 2019, 6% in 2020, 7% in 2012, and 8% in 2022.
CMS estimates that, with the 8% level, 10% of the HHAs could see a rate reduction of 3% or greater.
CMS further estimates a payment redistribution of $380 million.
The rule is available here.
The National Association for Home Care & Hospice (NAHC) continues to analyze the 297-page rule. Stay tuned to NAHC Report for further analysis.