Home Health Value-Based Purchasing Demonstration - 7/8/2015

CMS has proposed to begin the Home Health Value-Based Purchasing Demonstration on January 1^st 2016 for all home health agencies in the nine states they have selected.  They divided the 50 states into nine groups.

Group 1 – VT, MA, ME, CT, RI, NH

Group 2 – DE, NC, MD, PA, NY

Group 3 – AL, GA, SC, NC, VA

Group 4 - TX, FL, OK, LA, MS

Group 5 – WA, OR, AK, HI, WY, ID

Group 6 – NM, CA, NV, UT, CO, AZ

Group 7 – ND, SD, MT, WI, MN, IA

Group 8 - OH, WV, IN, MO, NE, KS

Group 9 – IL, KY, AR, MI, TN

They have selected one state from each of the nine groups

Group 1 – Massachusetts

Group 2 – Maryland

Group 3 – North Carolina

Group 4 - Florida

Group 5 – Washington

Group 6 – Arizona

Group 7 – Iowa

Group 8 - Nebraska

Group 9 – Tennessee

CMS will use OASIS data, HHCHAPS data, paid claims data, and four new data elements for scoring.  Each state will be divided into large providers and small providers and their score will compared to their group for their state.  January 1, 2015 to December 31, 2015 will serve as the base year for the providers. 

Scores	Impacts Payment Rates	Impact
1/1/16 to 12/31/16	1/1/18 to 12/31/18	+ or –  5%
1/1/17 to 12/31/17	1/1/19 to 12/31/19	+ or –  5%
1/1/18 to 12/31/18	1/1/20 to 12/31/20	+ or –  6%
1/1/19 to 12/31/19	1/1/21 to 12/31/21	+ or –  8%
1/1/20 to 12/31/20	1/1/22 to 12/31/12	+ or –  8%

Over half of the Proposed Home Health PPS Rules & Rates section related to the New Home Health Value-Based Purchasing Model.  There are numerous rules, regulations, and tables for this section.  Most of us have heard that something is so complicated that it takes a Philadelphia lawyer to explain it to us.  Well these rules will take that lawyer, a statistician, a home health nurse, an accountant and a home health coder to fully explain.  I encourage all of you to read this proposed rule very carefully even if you are not located in one of the chosen states.

We will discuss the Home Health Value-Based Purchasing Model and the Proposed Home Health PPS Rules and Rates in detail in two of our sessions at our Cutting Edge Home Health Leadership Summit that will be held at the Wailea Beach Marriott Resort and Spa on August 12^th to 14^th.   We have spoken to the hotel and extended the cutoff for reservation to July 9^th.  This will be the last extension given by the hotel.  Reservations made after this date will be based on hotel availability any could be at a higher rate.  To help home health agencies with the cost of registration we will extend the $1,099 for the first person and $949 for additional person’s registration until July 9^th.   We highly recommend you attend this seminar.  It will give you an opportunity to prepare for the drastic changes that will occur for the home health industry.

To view the draft form of the rule please go to:

https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-16790.pdf

The rule will be published in the Federal Register on July 10^th.  At that time you will need a new link which we will publish in a future email alert.