The payment rate portion of the CY 2017 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Final Rule released on October 31, 2016 contains only minor changes from the proposed rule (CMS-1648-PMedicare and Medicaid Programs; CY 2017 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements that resulted in a slight rate reduction.

Some important sections of the CY 2017 Home Health Final Rule include:

  • Medicare payments to home health agencies in CY 2017 would be reduced by 0.7 percent. The estimated decrease reflects the effects of the 2.5 percent home health payment update percentage; the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates, and the non-routine medical supplies (NRS) conversion factor (an impact of -2.3 percent decrease); and 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 expected impact of -0.9 percent.
  • HHAs who have a high volume of outlier visits may receive a decrease in their payment due to the change for calculation of outlier payments from a cost per visit approach to a cost per unit approach and adding a cap on the amount of time per day that can be counted toward the estimation of an episode’s cost for outliers 
  • Implement a separate payment for Negative Pressure Wound Therapy (NPWT) using a disposable device on or after January 1, 2017 set equal to the payment made under the Medicare Hospital Outpatient Prospective Payment System (OPPS)

Quality Reporting Program  

In this final rule  beginning with the CY 2018 payment determination, CMS adopted four measures to meet the requirements of the IMPACT Act:

  • Potentially Preventable 30-Day Post-Discharge Readmission Measure for Post-Acute Care 
  • Total Medicare Spending per Beneficiary - Post Acute Care 
  • Discharge to Community- Post Acute Care 
  • Drug Regimen Review Conducted with Follow-Up for Identified Issues-Post-Acute Care 

Home Health Value-Based Purchasing (HHVBP) Model 

The Home Health Value-Based Purchasing (HHVBP) Model is now being implemented in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington.

In the CY 2017 Home Health Final Rule CMS is finalizing the following changes to the Home Health Value-Based Purchasing (HHVBP) Model:

  • Calculate benchmarks and achievement thresholds at the state level rather than based on smaller/larger-volume cohort levels, eliminating increased variation caused by having too few HHAs in a cohort.
  • Require a minimum of eight HHAs in any size-cohort 
  • Increase the time frame for submitting New Measure data from seven calendar days to fifteen calendar days following the end of each reporting period
  • Remove four measures (Care Management: Types and Sources of Assistance, Prior Functioning ADL/IADL, Influenza Vaccine Data Collection Period, and Reason Pneumococcal Vaccine Not Received) 
  • Adjust the reporting period and submission date for the Influenza Vaccination Coverage for Home Health Personnel measure from a quarterly submission to an annual submission beginning April 2017
  • Implement an appeals process for HHAs to request recalculation of the Interim Performance Report scores and/or the Annual TPS and Payment Adjustment Report scores. 

LeadingAge had submitted comments on the Home Health 2017 Proposed Rule. MedPAC also submitted comments on the CY 2017 Home Health proposed rule.   The LeadingAge home health calculator was updated with the CY 2017 final rule data.