{"id":524,"date":"2018-11-07T16:33:10","date_gmt":"2018-11-07T16:33:10","guid":{"rendered":"https:\/\/advantagehcconsulting.com\/blog\/?p=524"},"modified":"2018-11-07T16:33:11","modified_gmt":"2018-11-07T16:33:11","slug":"hh-pps-final-rule-with-pdgm-payment-reform-is-out","status":"publish","type":"post","link":"https:\/\/advantagehcconsulting.com\/blog\/2018\/11\/07\/hh-pps-final-rule-with-pdgm-payment-reform-is-out\/","title":{"rendered":"HH PPS Final Rule With PDGM Payment Reform Is Out"},"content":{"rendered":"\n<figure class=\"wp-block-image is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/advantagehcconsulting.com\/blog\/wp-content\/uploads\/2018\/11\/hha_pps_final_rule_2018.png\" alt=\"\" class=\"wp-image-525\" width=\"503\" height=\"461\" srcset=\"https:\/\/advantagehcconsulting.com\/blog\/wp-content\/uploads\/2018\/11\/hha_pps_final_rule_2018.png 387w, https:\/\/advantagehcconsulting.com\/blog\/wp-content\/uploads\/2018\/11\/hha_pps_final_rule_2018-300x275.png 300w, https:\/\/advantagehcconsulting.com\/blog\/wp-content\/uploads\/2018\/11\/hha_pps_final_rule_2018-210x193.png 210w\" sizes=\"auto, (max-width: 503px) 100vw, 503px\" \/><\/figure>\n\n\n\n<p><strong><em>Retained behavioral adjustment provision ruins new model, trade group insists.<\/em><\/strong><\/p>\n\n\n\n<p>Medicare issued its Home Health Prospective Payment System final rule on Halloween, and it contains some provisions scarier than any monsters.<\/p>\n\n\n\n<p>As expected, the&nbsp;<strong>Centers for Medicare &amp; Medicaid Services&nbsp;<\/strong>adopted a final rule that is essentially the same as the proposed rule issued in July (<em>see Eli\u2019s HCW, Vol. XXVII, No. 24-25<\/em>). That means it contains a Patient-Directed Groupings Model payment reform plan that will take effect in January 2020. PDGM will be budget-neutral and will:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>shorten home health episodes to 30 days;<\/li><li>eliminate therapy from the HH PPS&nbsp;case mix&nbsp;system; and<\/li><li>significantly revamp the&nbsp;case mix&nbsp;methodology.<\/li><\/ul>\n\n\n\n<p>CMS has increased the clinical grouping categories \u201cby moving up to 12 with the additions of subgroupings,\u201d points out finance expert&nbsp;<strong>Mark Sharp&nbsp;<\/strong>with&nbsp;<strong>BKD&nbsp;<\/strong>in Springfield, Missouri.<\/p>\n\n\n\n<p>That doubles the number of categories, the&nbsp;<strong>National Association for Home Care &amp; Hospice&nbsp;<\/strong>explains in a rule summary. \u201cCMS agreed to add seven subgroups within the MMTA clinical group to improve payment accuracy,\u201d NAHC notes.<\/p>\n\n\n\n<p><strong>And:&nbsp;<\/strong>\u201cTherapy thresholds encourage volume over value and do not acknowledge that all patients are not the same, with some patients having complex needs that do not involve a lot of therapy,\u201d CMS notes in a fact sheet about the rule. \u201cThe PDGM removes the current incentive tooverprovide&nbsp;therapy, and instead, is designed to reflect CMS focus on relying more heavily on clinical characteristics and other patient information to allow payments to more closely reflect patients\u2019 needs.\u201d<\/p>\n\n\n\n<p>The rule \u201cfocuses on patient needs and not on the volume of care,\u201d CMS Administrator&nbsp;<strong>Seema Verma&nbsp;<\/strong>says in a release.<\/p>\n\n\n\n<p>PDGM is expected to create groups of winners and losers, with it sometimes being difficult to determine which is which prospectively.<\/p>\n\n\n\n<p>PDGM \u201cis a modestly adjusted and warmed-over version of the highly criticized 2017 Home Health Groupings Model proposal, says NAHC President&nbsp;<strong>William Dombi<\/strong>. \u201cMany of the same weaknesses present in HHGM exist in this new version.\u201d Most observers probably won\u2019t be surprised that \u201cPDGM is moving forward with the core structure intact,\u201d Sharp tells&nbsp;<strong>Eli<\/strong>.<\/p>\n\n\n\n<p><strong>Plus:&nbsp;<\/strong>While it\u2019s good that PDGM will be budget neutral as required by law, it still contains \u201ca significant \u2018behavioral adjustment\u2019 based solely on assumptions of behavioral changes that HHAs might undertake in the future,\u201d Dombi blasts in a statement about the rule. \u201cRate reductions based on behavioral changes that have not yet occurred create significant dangers for home health patients.\u201d<\/p>\n\n\n\n<p>Dombi expresses frustration that \u201cwe addressed these same concerns with CMS through the rulemaking process only for our concerns to be rejected in toto.\u201d He adds, \u201cwe have supported rational payment model reforms for many years. While the new model does include some good system refinements, its foundation is severely weakened by an unwarranted and unsupported rate reduction based on nothing but pure assumptions that home health agencies will abuse the payment process.\u201d<\/p>\n\n\n\n<p><strong>Good news:&nbsp;<\/strong>CMS projects that Medicare payments to HHAs in 2019 will increase by 2.2 percent, or $420 million, according to the rule scheduled for publication in the Nov. 13&nbsp;<em>Federal Register<\/em>. That\u2019s slightly higher than the 2.1 percent cited in the July proposed rule.<\/p>\n\n\n\n<p>The pay boost \u201cis welcome,\u201d Sharp notes. It\u2019s \u201cthe best annual increase for home health agencies since 2007, I believe,\u201d he adds. It comes after eight straight years of reimbursement rate cuts.<\/p>\n\n\n\n<p>Other provisions in the final rule:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>eliminate the requirement that the certifying physician estimate how much longer skilled services are required when recertifying the need for continued home health care. \u201cThis policy is responsive to industry concerns about regulatory burden reduction and could reduce claims denials that solely result from an estimation missing from the recertification statement,\u201d CMS says in the release. CMS estimates an annual cost savings to certifying physicians of $14.2 million beginning in CY 2019.<\/li><li>revamp rural add-on amounts in accordance with the Balanced Budget Act of 2018, based on location. Ultimately CMS will phase out the add-on;<\/li><li>make remote patient monitoring costs allowable in Medicare cost reports. This change is both surprising and \u201clong overdue,\u201d Sharp cheers;<\/li><li>implement a temporary transitional payment system for home infusion therapy services in 2019 and 2020. A final system will take effect in 2021;<\/li><li>change the criteria and procedures for removing previously adopted Home Health Quality Reporting measures; and<\/li><li>tweak the HH Value-Based Purchasing system.<\/li><\/ul>\n\n\n\n<p><em>Note: For more rule details as well as expert insight and analysis, see the next issue of Eli\u2019s Home Care Week. The 682-page rule is at<a href=\"https:\/\/s3.amazonaws.com\/public-inspection.federalregister.gov\/2018-24145.pdf\">https:\/\/s3.amazonaws.com\/public-inspection.federalregister.gov\/2018-24145.pdf<\/a>.<\/em><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><strong><em><a href=\"https:\/\/www.supercoder.com\/coding-newsletters\/my-homecare-week-alert\/prospective-payment-system-hh-pps-final-rule-with-pdgm-payment-reform-is-out-159148-article\">Source- SuperCoder<\/a><\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Retained behavioral adjustment provision ruins new model, trade group insists. Medicare issued its Home Health Prospective Payment System final rule on Halloween, and it contains some provisions scarier than any &hellip; <a class=\"readmore\" href=\"https:\/\/advantagehcconsulting.com\/blog\/2018\/11\/07\/hh-pps-final-rule-with-pdgm-payment-reform-is-out\/\">Continue Reading &rarr;<\/a><\/p>\n","protected":false},"author":1,"featured_media":525,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[11],"class_list":["post-524","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-reimbursement","tag-home-care"],"_links":{"self":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/524","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/comments?post=524"}],"version-history":[{"count":1,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/524\/revisions"}],"predecessor-version":[{"id":526,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/524\/revisions\/526"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media\/525"}],"wp:attachment":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media?parent=524"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/categories?post=524"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/tags?post=524"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}