Proposed Home Health PPS Rules & Rates for 2016 - 7/7/2015

CMS has issued the Proposed Home Health PPS Rules & Rates for 2016 late Monday July 6^th.  This is the first of several email alerts that we will publish this week on the information contained in the proposed rules & rates for 2016.  Listed below are the factors used to create the 2016 National Standardized 60-Day Episode Payment Rate.

2015 National Base Rate                                                     $2,961.38

Wage Index Budget Neutrality Factor           (Times)      1.0006

Case-Mix Weights Budget Neutrality Factor (Times)      1.0141
Nominal Case-Mix Growth Adjustment      (Times)       0.9828

2016 Rebasing Adjustment                               (Minus)    ($80.95)

Inflation Update 2016                                         (Times)       1.0230

2016 National Standardized 60-Day Episode Rate   $2,938.37

The above rate is the national standardized 60-day episode payment rate.  This rate will be increased by 3% for home health agency patients in rural areas.  This rate will be reduced by 2% for home health agencies that did not submit quality data.  CMS has fully implemented the 2^nd year phase in of the wage index, which must be applied to the labor portion of the national rate.  CMS reduced the case-mix rates by 1.0141%.  They have made some changes to the case-mix point system.  All of the above will impact the actual payment for an individual Medicare Beneficiary Home Health Claim.   CMS also adjusted the LUPA payment rates and the Medical Supply payment rates.  We will discuss more on the Medicare home health payment rates in future email alerts.

CMS has issued proposed rules for the Home Health Value-Based Purchasing Model.  They have divided the 50 states into nine geographic groups.  They have selected nine states to participate in the Home Health Value-Based Purchasing Model Demonstration Program.  Every home health agency in the state chosen must participate, you do not have a choice.  The nine states chosen are Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee.  (The states could change when they publish the final rule, but we do not believe they will make any changes.)  We will discuss more on the Home Health Value-Based Purchasing Model in future email alerts.

We will discuss this proposed rule in detail in our Home Health Update session and have another session on the Home Health Value-Based Purchasing Model at the 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