CMS Proposed Rule: Updates to Home Health Care, Payment Rates and Value-based Models

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on Monday that will expand the home health value-based purchasing (HHVBP) model, which was originally developed by the Center for Medicare & Medicaid Innovation (CMMI) in 2016. The rule also includes updates to the Medicare Home Health Prospective Payment System (HH PPS) and home infusion therapy payment rates for calendar year 2022.

The payment rate increase for home health agencies in CY 2022 is recommended at 1.7% increase, or $310 million. According to McKnight’s Senior Living, the 2% increase to the same sector translated to $410 million. The National Association for Home Care & Hospice President Bill Dombi said the industry sees this as a measured approach in unstable times:

NAHC agrees that CMS should be cautious at this unsettled time and we recommend CMS avoid taking premature steps that could disrupt a fragile healthcare system based on a myriad of assumptions and limited data from a chaotic period. In that respect, NAHC appreciates that CMS is avoiding taking potential actions without reliance on comprehensive data.

According to the factsheet from CMS, the HHVBP model is intended to reward health agencies for high-quality care and Medicare savings. Fierce Healthcare reports that it incentivizes quality improvements without limiting coverage or withholding Medicare benefits and includes updates to payment rates and policies. From CMS Administrator Chiquita Brooks-LaSure:

Today’s announcement is a reaffirmation of our commitment to these older adults and people with disabilities who are counting on Medicare for the health care they need. This proposed rule would streamline service delivery and value quality over quantity—at a time when Americans need it most.

The gigantic rule also includes the creation of a Special Focus Program (SFP) which would provide enforcement solutions with poor performance on regulatory surveys and would implement a hospice program complaint hotline for the public to report concerns and issues to CMS. According to Hospice News, hospices flagged would be surveyed every six months instead of every three years. Implementation is expected to cost an additional $5.5 million annually.

CMS Fact Sheet

Full Proposed Rule at the Federal Register