2017 Home Health PPS Payment Update

On June 30, 2016, in Announcements, by AQ-IQ LLC

CMS projects that Medicare payments to home health agencies in CY 2017 would be reduced by 1.0 percent, or $180 million based on the proposed policies. The proposed decrease reflects the effects of the 2.3 percent home health payment update percentage ($420 million increase); the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates, and the non-routine medical supplies conversion factor ($420 million decrease); the effects of the -0.97 percent adjustment to the national, standardized 60-day episode payment rate to account for nominal case-mix growth for an impact of -0.9 percent ($160 million decrease); and the effects of the proposed increase to the fixed-dollar loss ratio used in determining outlier payments from 0.45 to 0.56 for an estimate impact of -0.1 percent ($20 million decrease).

Proposed changes include:

  • Rebasing the 60-day episode rate
  • Updates to reflect case-mix growth
  • Negative pressure wound therapy
  • Change in methodology and the fixed-dollar loss ratio used to calculate outlier payments
  • HH Value-Based Purchasing Model

CMS also proposes to adopt four measures for the CY 2018 payment determination to meet the requirements of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). Three of these measures are resource-based and calculated using Medicare claims. The fourth measure is assessment-based and is calculated using Outcome and Assessment Information Set (OASIS) data. Proposed measures:

  • All-condition risk-adjusted potentially preventable hospital readmission rates
  • Total estimated Medicare spending per beneficiary
  • Discharge to the community
  • Medication reconciliation

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