The Centers for Medicare & Medicaid Services (CMS) issued a rule that finalizes a nationwide expansion of the successful Home Health Value-Based Purchasing (HHVBP) Model and makes updates to the Medicare Home Health Prospective Payment System (PPS) and the home infusion therapy services payment rates for Calendar Year (CY) 2022, in accordance with existing statutory and regulatory requirements.

Some key provisions in this final rule include:

  • CMS is expanding the HHVBP Model nationwide. The first performance year will be CY 2023, with quality performance data from that year used to calculate payment adjustments in CY 2025.
  • CMS estimates that Medicare payments to Home Health Agencies (HHAs) in CY 2022 would increase in the aggregate by 3.2% ($570 million). The increase in estimated payments reflects a payment update of 2.6%, a 0.7% increase due to the fixed-dollar loss ratio, and a 0.1% decrease in payments that came from changes to the rural add-on percentages.
  • CMS finalized the recalibration of the PDGM case-mix weights, functional levels, and comorbidity adjustment subgroups while maintaining the CY 2021 LUPA thresholds for CY 2022 to more accurately pay for the types of patients HHAs are serving.
  • Since Occupation Therapists (OTs) can now conduct the initial and comprehensive assessments, CMS is establishing a LUPA add-on factor for calculating the LUPA add-on payment amount for the first skilled occupational therapy visit in LUPA periods that occurs as the only period of care or the initial 30-day period of care in a sequence of adjacent 30-day periods of care.
  • The final home infusion therapy payment rate update for CY 2022 is 5.1%.
  • Changes to Home Health (HH) Quality Reporting Program (QRP):
    • Removal of an OASIS based measure, the Drug Education on All Medications Provided to Patient/Caregiver During All Episodes of Care measure, due to high performance, beginning January 1, 2023.
    • Replacement of the Acute Care Hospital During the First 60 Days of Home Health measure and the Emergency Department Use Without Hospitalization During the First 60 Days of Home Health measure with the Home Health Within-Stay Potentially Preventable Hospitalization measure, beginning with the CY 2023 HH QRP.
    • Finalization to begin public reporting the Percent of Residents Experiencing One or More Major Falls with Injury measure and Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function measure beginning in April 2022.
    • Home health agencies will collect the Transfer of Health Information (TOH) to Provider Post-Acute Care measure, the Transfer of Health Information to Patient-PAC measure, and certain Standardized Patient Assessment Data Elements (SPADES) beginning January 1, 2023.
  • Changes to the Home Health Conditions of Participation (CoPs): CMS finalized selected regulatory blanket waivers related to home health aide supervision and the use of telecommunications in conducting assessment visits that were issued to Medicare participating home health agencies during the COVID-19 PHE.
  • This final rule incorporates into regulation several Medicare provider enrollment sub-regulatory policies, including but not limited to, (1) deactivations; (2) the rejection and return of provider enrollment applications; and (3) the establishment of effective dates for various provider enrollment transactions.
  • CMS finalized changes to increase and improve transparency, oversight, and enforcement for hospice programs in addition to implementing the provisions of Division CC, section 407(b) of Consolidated Appropriations Act, 2021 (CAA).

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

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