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CMS ODF Addresses Home Health, Hospice Rules, Hospice Claims Processing

Posted on Tuesday, August 18, 2015 8:57 AM

CMS held its Home Health, Hospice & DME Open Door Forum on August 12, 2015. CMS representatives outlined changes that were included in the final hospice payment rule for FY 2016, which was issued on Friday, July 31. The staff highlighted the following:
  • The final phase-out of the budget neutrality adjustment actor (BNAF) to the hospice wage index;
  • Alignment of the accounting year for the hospice aggregate and inpatient CAPS with the federal fiscal year;
  • Modification of the update factor for the aggregate cap to reflect the annual percentage rate update to hospice (rather than the CPI-U);
  • Imposition of a two-tiered rate of payment for Routine Home Care (eff. Jan. 1, 2016);
  • Implementation of a Service Intensity Add-on for skilled visits in the last 7 days of life (eff. Jan. 1 2016);
  • Use of a single RHC rate from Oct. 1 - Dec. 31, 2015;
  • Clarification that hospices are required to include all diagnoses gathered during the comprehensive assessment on hospice claims (including mental health disorders and other conditions affecting the plan of care) and regardless of whether the diagnoses are related or unrelated to the terminal diagnoses and related conditions.
HOME HEALTH: As part of the home health proposed payment rule for CY2016, CMS is proposing one new quality measure for CY2016 -- skin integrity/the percent of patients with pressure ulcers that are new or worsened -- to meet requirements under the IMPACT Act. CMS also proposed to raise the pay for reporting threshold:
  • Beginning CY2016 payment determination, CMS is requiring 70 percent timely OASIS submissions for the July 1, 2015 - June 30, 2016 time period
  • July 1, 2016 - June 30, 2017 HHAs must meet an 80 percent timeliness requirement for OASIS submissions
  • July 1, 2017 through June 30, 2018, (and thereafter) HHAs must meet the 90 percent timeliness submission threshold for OASIS submissions.
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