The proposed PPS Rule for Dwelling Nursing CY 2022 would prolong the value-based buying mannequin and search to gather well being fairness knowledge by a high quality reporting program Baker Higher Well being Legislation

On July 7, 2021, the Centers for Medicare & Medicaid Services (CMS) published their proposed rule to update the Calendar Year (CY) 2022 Home Health Prospective Payment System (HH PPS) and the Value-Based Purchasing (HH VBP) program. In the proposed rule, CMS notes that its experience with the value-based home health purchase model has been successful enough to warrant a nationwide rollout of the model earlier than expected. The agency also seeks to gather information to guide its efforts in collecting data on equal opportunities in health that can influence policy development. The proposed rule affects aspects of home nursing, hospice, long-term hospital and inpatient rehabilitation facilities, reimbursement, data collection and reporting. CMS is accepting comments on the proposed rule until August 27, 2021.

Early expansion of the value-based purchasing model for home nursing

CMS wants to capitalize on the success of the CMS Innovation Center HH VBP model by proposing to end the model in the original model states a year earlier and to expand the model nationwide by January 1, 2022. The model is designed to incentivize improvements in the quality of care for older adults and people with disabilities who rely on Medicare at home without denying or reducing coverage or benefits to Medicare beneficiaries. In its most recent assessment, the Home Health Agency model participants showed an average improvement in their quality scores of 4.6 percent and an average annual saving of $ 141 million for the Medicare program.

Payment updates and policy changes

CMS proposes the following payment updates and policy changes for home health authorities and home infusion therapy providers in FY 2022:

  • Patient-controlled grouping model (PDGM)

    In January 2020, Medicare introduced the PDGM and a 30-day payment unit to better tailor the Home Health Prospective Payment System (HH PPS) to patient care needs and ensure clinically complex beneficiaries had adequate access to home health care. In implementing these changes, CMS finalized three behavioral assumptions regarding clinical group coding, comorbidity coding and a low usage payment amount (LUPA), which resulted in a reduction to the nationally standardized 30-day payment rate for the CY 2020.

    In the proposed rule, CMS asks for an opinion on the method it describes in order to fulfill its legally mandated responsibility to determine the effects of the differences between the assumed behavioral changes and the actual behavioral changes and to adjust the 30-day payment amount accordingly. In this context, CMS also suggests:

    • Recalibrating PDGM-associated case mix weights, functional levels, and comorbidity adjustments using the more recent data from the CY 2020 to increase payment accuracy for the types of patients cared for by home health authorities;
    • Maintaining the LUPA thresholds from CY 2021 to CY 2022;
    • Adaptation to the wording of the ordinance to enable the implementation of a new legal provision according to which occupational therapists can perform an initial and overall examination through home nursing for all Medicare beneficiaries, provided that the care plan does not initially include qualified care but includes both physiotherapy or Speech pathology; and
    • Use of a LUPA add-on factor for physical therapy as a proxy for the average excess of minutes for the first LUPA periods in which the first and comprehensive visits by occupational therapists are carried out, until a more precise add-on factor based on CY 2022 -Data can be set.
  • Home Infusion Therapy Benefits for CY 2022

    CMS proposes to fulfill a separate legal mandate by updating the payment rates for home infusion therapy services for the CY 2022. The agency also recommends updating the geographic adjustment factor used for the wage adjustment, but maintaining the payment guideline for first and subsequent visits as set out in CY 2020 HH PPS Final rule with comment period. Overall, CMS expects the economic impact of the updated home infusion therapy reimbursement rates to be minimal.

Proposals for a health quality reporting program

CMS makes several proposals on the Home Health Quality Reporting Program (HH QRP), including proposed guidelines to promote equity in healthcare, in line with President Biden’s most recent Executive Order 13985. The proposed rule includes two Requests for Information (RFI). The first RFI seeks feedback on methods of achieving health equity through policy measures. The agency plans to improve data collection so it can better measure and analyze disparities between its programs and policies to address significant and persistent inequalities in health outcomes among Americans. The second RFI asks for feedback on the future plans of CMS to define digital quality measures for the HH QRP and the potential use of Fast Healthcare Interoperability Resources.

In addition, CMS makes several suggestions for the operation of the HH QRP, in particular:

  • Improve the program of reporting on quality of home health by removing or replacing certain quality measures;
  • Introduce a claims-based intervention that addresses attribution concerns with an intervention that is more closely related to desired patient outcomes; and
  • Start of data collection on the post-acute care transfer of health information to the provider and six categories of standardized data elements for patient assessment to better support care coordination:
    • Health authorities would begin collecting the data on January 1, 2023, and
    • Nursing hospitals and inpatient rehabilitation facilities would start collecting data from October 1, 2022.

Home Health Conditions of Participation

The agency proposes allowing home health workers to use interactive telecommunications systems during the 14-day oversight assessment only for unplanned events that would otherwise disrupt planned face-to-face visits.

Collection and enforcement requirements for hospice programs

CMS suggests improving the survey process in the hospice program by changing the composition of the survey teams, creating new enforcement mechanisms and authorities, and strengthening the role of Accreditation Organizations (AOs). In detail, CMS suggests:

  • require the use of multidisciplinary survey teams;
  • Prohibiting Conflicts of Interest from Surveyors;
  • Establishment of a complaints hotline for hospice programs;
  • Create a special focus program for underperforming hospice programs;
  • Empower CMS to impose new enforcement measures on non-compliant hospice programs to encourage underperforming hospice programs to substantially meet CMS requirements before CMS is required to terminate the hospice provider contract; and
  • for AOs that accredit and “evaluate” hospice programs, such as the Accreditation Commission for Healthcare, the Community Health Accreditation Partner and the Joint Commission:
    • Expansion of the CMS-based surveying training to AOs
    • AOs with CMS-approved hospice programs must begin using Form CMS-2567.

Interested stakeholders must submit their comments either electronically via or by post, express or overnight mail directly to CMS in order for them to be received on August 27, 2021 at 5:00 p.m. ET.

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