The Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2023 Home Health Prospective Payment System (HH PPS) Rate Update final rule (CMS-1766-F), which updates Medicare payment policies and rates for home health agencies (HHAs). This rule includes routine updates to the Medicare Home Health PPS and the home infusion therapy services’ payment rates for CY 2023, in accordance with existing statutory and regulatory requirements.

Here’s what you need to know:

  • CMS estimates that Medicare payments to HHAs in CY 2023 will increase in the aggregate by 0.7%, or $125 million compared to CY 2022.
  • This increase reflects the effects of the 4.0% home health payment update percentage ($725 million increase), an estimated 3.5% decrease that reflects the effects of the prospective permanent behavioral assumption adjustment of -3.925% ($635 million decrease) that is being phased-in, and an estimated 0.2% increase that reflects the effects of an update to the fixed-dollar loss ratio (FDL) used in determining outlier payments ($35 million increase).
  • This rule finalizes a permanent, budget neutral 5% cap on negative wage index changes (regardless of the underlying reason for the decrease) for home health agencies to smooth year-to-year changes in the pre-floor/pre-reclassified hospital wage index.
  • CMS is finalizing recalibration of the case-mix weights (including the functional levels and comorbidity adjustment subgroups) and LUPA thresholds using CY 2021 data to more accurately pay for the types of patients HHAs are serving.
  • The rule includes a discussion of the comments received on the future collection of data regarding the use of telecommunications technology during a 30-day home health period of care on home health claims, for which we will begin collecting data voluntarily January 1, 2023, and will then require on a mandatory basis July 1, 2023.
  • The final home infusion therapy payment rate update for CY 2023 is 8.7%. The single payment amounts are also adjusted in a budget neutral manner using standardization factors for geographic area wage differences using the geographic adjustment factors (GAF).
  • Additionally, this rule finalizes changes to the Home Health Quality Reporting Program (HH QRP) requirements; changes to the Expanded Home Health Value-Based Purchasing (HHVBP) Model; and summarizes the input received on the health equity request for information (RFI) for both HH QRP and HHVBP.

Source: U.S. Centers for Medicare & Medicaid Services (CMS)

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