Upgrading Medicare Home Health

CMS https://www.cms.gov has made significant changes to the “Home Health Prospective Payment System” to strengthen and modernize Medicare. CMS has made the changes to improve access via remote patient monitoring technology, to update payments for home healthcare with a new case-mix system, and initiated the new home infusion therapy benefit.

Beginning in 2020, CMS will implement the new case-mix system called the “Patient-Driven Groupings Model (PDGM) that will put the focus on patient needs rather than on the volume of care. Changes in data collection under the new case-mix system coupled with the changes regarding meaningful measures and the Home Health Quality Reporting Program, will reduce the burden for home health agencies by about $60 million beginning in 2020.

CMS will allow the cost of remote patient monitoring to be reported by home health agencies as allowable costs on the Medicare cost report form. This is expected to help foster the adoption of emerging technologies by home health agencies and result in more effective care planning, as data is shared with patients, caregivers, and providers.

Another rule implements the temporary transitional payments for home infusion therapy services for calendar years 2019 and 2020 until the new permanent home infusion therapy services benefit begins January 1, 2021.

CMS is also eliminating the requirement that the certifying physician estimate how much longer home health services are needed when recertifying the need for continued home healthcare. This is estimated to result in an estimated reduction in burden for physicians of $14.2 million annually.

The final rule helps advance the CMS “Comprehensive Meaningful Measures Initiative”. CMS is removing seven Home Health Quality Reporting Program measures. Therefore, changes in data collection under the new case-mix system, coupled with the changes from removal of several measures will reduce the burden for home health agencies by about $60 million annually beginning in calendar year 2020.

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