Home Health Calendar Year 2019-20 Finalized Rules

CMS finalizes the calendar year 2019 and 2020 payment and policy changes for Home Health Agencies and Home Infusion Therapy suppliers.

The 374-page rule sets out conditions for home health agencies to be able to participate in federal Medicare and joint federal-state Medicaid programs.

  • Finalized Calendar Year (CY) 2019 Medicare payment updates
  • Finalized quality reporting changes for home health agencies (HHAs)
  • Finalized case-mix methodology refinements
  • Change in the home health unit of payment from 60 days to 30 days for CY 2020.

Implementation of temporary transitional payments for home infusion therapy services to begin on January 1, 2019.

Three pillar policy

  • Empowering patients
  • Increasing competition
  • Fostering innovation

Emphasize on care and modernization of Medicare through

  • Innovations in home health
  • The new home infusion therapy benefit
  • Meaningful quality measure reporting
  • Reduced paperwork
  • Reduced administrative costs

Payment Rate Changes under the HH PPS for Cy 2019

Based on the finalized policies, Medicare payments to HHAs in CY 2019 will be increased by 2.2 percent, or $420 million.

Modernizing the HH PPS Case-mix Classification System and Promoting Patient-Driven Care

The Bipartisan Budget Act of 2018

  • Change in the unit of payment under the HH PPS, from 60-day episodes of care to 30-day periods of care
  • Stop using the number of therapy visits provided to determine home health payment

Patient-Driven Groupings Model

Eliminates the current incentive to over-provide therapy

Clinical characteristics and other patient information to closely resemble payment and patient need

Reduce the administrative burden associated with the HH PPS

Fostering Innovation

  • The Use of Remote Patient Monitoring under the Medicare Home Health Benefit

Allows patients to share more live-time data with providers and caregivers, leading to more tailored care and better health outcomes

  • New Home Infusion Therapy Services Temporary Transitional Payment and Home Infusion Therapy Benefit

Finalizes elements of the permanent home infusion benefit including

  • The health and safety standards for home infusion therapy
  • An accreditation process for qualified home infusion therapy suppliers
  • An approval and oversight process for the organizations that accredit qualified home infusion therapy suppliers

Home Health Quality Reporting Program (HH QRP) Provisions

  • Removing previously adopted HH QRP measures based on eight measure removal factors
  • Removal of seven quality measures based upon one of these eight finalized measure removal factors
  • Not all OASIS data is used to determine whether an HHA has satisfied the HH QRP reporting requirements for a program year

Home Health Value-Based Purchasing Model

  • Developing public reporting of performance under the HHVBP Model
  • Removal of two Outcome and Assessment Information Set based measures, Influenza Immunization Received for Current Flu Season and Pneumococcal Polysaccharide Vaccine Ever Received from the set of applicable measures
  • Replacement of three OASIS based measures with two new composite measure son total change in self-care and mobility
  • Changes to the calculation of Total Performances Scores by changing the weighting methodology for OASIS-based, claims-based, and HHCAHPS measures
  • Change to the scoring methodology by reducing the maximum amount of improvement points and HHA can earn

Regulatory Burden Reduction

  • Eliminating the requirement that the certifying physician estimate the duration of requiring skilled service when recertifying the need for continued home health care
  • Amendments to current regulations to align them with current sub-regulatory guidance
  • These burden reduction efforts would allow providers to spend more time on their chief responsibility: improving the health outcomes of their patients

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Riya James

Riya James

A writer in Healthcare domain, trying to connect those in need with those who can help. Part-time explorer and artist.
Riya James

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