PPS Final Rule means less payment in 2011

The home health PPS final rule for 2011 is out, and the result is lower episodic rates than in 2010. The base rate will be between $2,312.94 to $2,192.07 — depending on the wage index where your HHA is located. This base is a reduction of $120.87 or 5.22%.

The National Association for Home Care and Hospice created this graphic to show the breakout of the payment calculation:

2010 episodic base rate
Divided by 0.975
2.5% outlier budget shift
Multiplied by 0.95
Outlier budget
Multiplied by 1.011
Market Basket Index minus 1%
Multiplied by 0.9621
3.79% case-mix case weight change adjustment
2011 Base Episode Rate

There are still different base rates for rural vs. non-rural areas.

LUPA payments have a different calculation, which does not use the 3.79% case-mix weight change adjustment. Again, from NAHC, the per-visit rates are as follow:

Non-rural Rural
Home health aide
$50.42 $51.93
Medical social services
$178.46 $183.81
Occupational therapist
$122.54 $126.22
Physical therapist
$121.73 $125.38
Skilled nursing
$111.32 $114.66
Speech language pathologist $132.27 $136.24

Non-routine medical supplies (NRS) are paid under a separate case-mix adjustment model. The NRS payment amounts are as follows:

Severity Level Non-Rural NRS Amount Rural NRS Amount
1 $14.18 $14.61
2 $51.18 $52.72
3 $140.34 $144.55
4 $208.51 $214.77
5 $321.53 $331.18
6 $553.00 $569.59

The examples above are just that. There are many other factors, such as whether an HHA has or has not submitted quality data, that can influence payment.

Looking for the final rule?

Want education? NAHC is conducting a webinar Friday, Nov. 5 (this Friday!) on the Final Rule. It’s from 2:30-4pm, EST.

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