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NAHC Webinar on the New Payment Rule Summary

Posted on Monday, November 12, 2018 1:35 PM

On October 31, 2018, the Centers for Medicare & Medicaid Services (CMS) released a final rule which includes finalized CY 2019 Medicare payment updates, finalized quality reporting changes for home health agencies (HHAs), and finalized case-mix methodology refinements for the Patient Driven Groupings Model (PDGM) and a change in the home health unit of payment from 60 days to 30 days for CY 2020. The PDGM model for home health services will begin on or after January 1, 2020.

This final rule also addresses the implementation of temporary transitional payments for home infusion therapy services to begin on January 1, 2019 and summarizes public comments related to full implementation of the new home infusion therapy benefit in CY 2021.

This new rule is detailed and incorporates changes in many different areas.  The payment changes are relatively minor, but positive overall.  Home Health Agencies need to work as quickly as possible to be ready for all the operational changes. 

The overall expected impact is:

  • 2019 HHPPS


– Outlier

‐‐+$20M –

Rural add‐on‐‐ ‐$20M

  • 2020 PDGM‐‐‐ Budget Neutral
  • Home Infusion Therapy‐‐‐ +$48M
  • OASIS changes

‐‐‐ $60M in annualized HHA savings

Some highlights of the new rule:

  • Market Basket Index

--Rebased input factors

– 76.1% labor‐related share

 – 3.0% update

 – 0.8% Productivity Adjustment

– 2.2% net increase

 – 2% reduction w/o quality data submission

  • Multiple wage index area changes
  • 2019 Outlier Formula

 – Continuing the cost per 15-minute unit approach

  • Amount to be published in the 2019 rate change request

 – Loss sharing ratio stays at .80

 – Fixed Dollar Loss ratio change from 0.55 to 0.51

  • Needed to spend the 2.5% outlier budget
  • Would increase incidence of outliers
  • CMS provides an ALS patient outlier illustration – $25k+ cost with $20k reimbursement


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