The Centers for Medicare and Medicaid Services (CMS) has released its proposed rule for the Home Health Prospective Payment System (HH PPS) for 2015, in anticipation of an estimated .3% net decrease to home health agencies. The American Physical Therapy Association (APTA) news reports that the rule suggests a home health market basket update of 2.2% adjusted for multifactor productivity as mandated by the Affordable Care Act (ACA) and includes a requirement that functional therapy reassessments be performed every 14 days.
According to the APTA news report, CMS will implement the second year of the ACA-required 4-year phase-in for rebasing adjustments to the HH PPS payment rate by decreasing home health payment by 3.5%. The proposed standardized 60-day episode payment for 2015 is $2,922.76, and the proposed per-visit amount for physical therapy in 2015 is $139.73 for home health agencies (HHAs) in compliance with quality reporting requirements.
CMS has also proposed several additional rules, including simplifying the home health therapy functional assessment by reversing the current requirements to complete the assessment at the 13th and 19th visits and/or at least every 30 days and instead requiring a qualified therapist from each discipline to provide the therapy and functionally reassess the patient at least every 14 days, as noted on the APTA news release. The requirement would apply to all episodes of care regardless of the number of therapy visits.
In addition, CMS has proposed noteworthy changes to the physician face-to-face encounter requirements. CMS also proposes that HHAs submit both admission and discharge outcome and assessment information set (OASIS) assessments for a minimum of 70% of all patients with care during the applicable reporting period, as noted on the APTA news report. The threshold would increase by 10% each year until reaching a cap of 90%.
APTA reports that CMS is inviting comments on a pilot value-based purchasing (VBP) model for HHAs that would begin in 2016. The organization hopes to test the model in up to eight states.