Earlier this summer the Centers for Medicare & Medicaid Services (CMS) published its Calendar Year (CY) 2019 home health agency (HHA) and home infusion therapy supplier payment updates proposed rule. On October 31, CMS published its CY 2019 final rule, which alters Medicare quality and payment reporting processes for HHAs under the Home Health Prospective Payment System (HH PPS). This new rule is part of an agency-wide transition from volume-based payments to value-based payments.

CMS projects that Medicare payments to HHAs in CY 2019 will be increased by 2.2 percent, or $420 million, based on the finalized policies. In the rulemaking CMS finalizes the implementation of changes required by Congress in the Bipartisan Budget Act of 2018. These revisions include changing the unit of payment under the HH PPS from 60-day episodes to 30-day periods of care, to be implemented January 1, 2020. Also beginning January 1, 2020, HH PPS payment will not be determined by the number of therapy visits. CMS finalizes its new case-mix system, termed the Patient-Driven Groupings Model (PDGM), that includes modifications to data collection and reporting that emphasize clinical characteristics and patient information to assign patients to the appropriate payment categories. The PDGM becomes effective on January 1, 2020.

A key component of the rule is the addition of Medicare coverage for remote patient monitoring, a term which is now defined. This coverage will increase beneficiary access to home health care.

In another move toward cost-effectiveness and administrative efficiency, physicians will no longer be required to estimate the duration of home health services when recertifying a patient’s need for this form of care, thereby eliminating some administrative burden that exists in the current system.

The rule also implements temporary transitional payments for home infusion therapy services through 2020, pursuant to requirements in the Bipartisan Budget Act of 2018. This temporary measure unless revised will be effective until the permanent home infusion therapy services benefit begins on January 1, 2021.

The final rule may be found here.