Posts tagged ‘market basket’

November 1, 2011

2012 payment changes are finalized

The down and dirty: Payments to home health agencies (HHAs) are estimated to decrease by approximately 2.31 percent or $430 million in CY 2012, the net effect of a 1.4 percent payment update, the wage index update, and the case-mix coding adjustment. 

Hypertension has officially been removed from the case-mix list, payments have dropped for high-therapy episodes, and case-mix weights have been recalibrated.

The Affordable Care Act applies a 1 percentage point reduction to the 2012 home health market basket amount.  As the 2012 market basket is equal to 2.4 percent, the payment update for HHAs in 2012 will be 1.4 percent, according to the Center for Medicare and Medicaid Services. 

CMS also reduced HH PPS rates in 2012 to account for additional growth in aggregate case-mix that is unrelated to changes in patients’ health status.  CMS has finalized a 3.79 percent reduction to the home health PPS rates for 2012 and an additional 1.32 percent reduction for 2013.

The final rule is in the Federal Register. .   

CMS’s main HH PPS page is here.

August 10, 2011

Hospieces receive payment bump

Hospices serving the Medicare population will see a 2.5 percent increase in their Medicare payments for fiscal year (FY) 2012, according to the Final Rule.

The estimated hospice payments are the net result of a 3.0 percent increase in the “hospital market basket,” an indicator of industry-related price increases, offset by an estimated 0.5 percent decrease in payments to hospices due to updated wage index data and the third year of CMS’ seven-year phase-out of a wage index budget neutrality adjustment factor.

See CMS’s release here

 

July 5, 2011

Payments will decrease if 2012 proposed rule goes into effect

A proposed rule in the Federal Register on Tuesday proposes a 3.35 percent decrease in Medicare payments to HHAs for calendar year 2012. This would be an estimated net decrease of $640 million compared to HHA payments in CY 2011.  It would include the combined effects of market basket and wage index updates (a $310 million increase) and reductions to the HHPPS rates to account for increases in aggregate case-mix that are largely related to billing practices and not related to  changes in the health status of patients (a $950 million decrease). 

Provisions of the Affordable Care Act (ACA) mandate that CMS apply a one (1) percentage point reduction to the CY 2012 home health market basket amount; this would equate to a proposed 1.5 percent update for HHAs next year.  As part of the HH PPS rate update, CMS also proposes to reduce HH PPS rates by 5.06 percent in CY 2012 to account for the increase in the case-mix that is unrelated to changes in patient acuity.

The Medicare HHA proposed rule would also make structural changes to the HH PPS by removing two hypertension codes from the case-mix system, lowering payments for high therapy episodes and recalibrating the HH PPS case-mix weights to ensure that these changes result in the same amount of total aggregate payments.      

The proposed home health market basket increase for CY 2012 is 1.5 percent.  HHAs that submit the required quality data would receive payments based on this full home health market basket update.  If an HHA does not submit quality data, the home health market basket percentage increase would be reduced by 2 percentage points to -0.5 percent for CY 2012.

See the proposed rule.

 

July 19, 2010

CMS proposes payment changes to HH services for 2011

CMS is proposing major changes in therapy qualifications, documentation and “effectiveness” of therapy in the 2011 proposed HHPPS rule. It is also proposing case-mix changes and payment changes.

This post gives an overall view and focuses on payment aspects.

The Centers for Medicare & Medicaid Services (CMS) announced late last week in its Home Health Prospective Payment System Rate Update for Calendar Year 2011 Proposed Rule a number of changes for HHAs and Hospice regarding certification, case-mix, therapy and skilled service documentation and requirements, and payment rates.

The proposed rule has a 4.75 percent decrease in Medicare payments to home health agencies (HHAs) for calendar year (CY) 2011. Based on updated data analysis, instead of the planned 2.71 percent reduction for CY 2011, CMS proposes to reduce HH PPS rates by 3.79 percent in CY 2011 and an additional 3.79 percent in CY 2012.

The agency estimates that this could be a $900 million decrease compared to payments HHAs received in CY 2010.  The decrease is a combination of market basket update, a wage index update, reductions to the home health prospective payment system (HH PPS) rates and other factors.

The Affordable Care Act (ACA) mandates a 1 percentage reduction to the CY 2011 home health market basket amount. The ACA also changes the existing home health outlier policy through a 5 percent reduction to HH PPS rates, with total outlier payments not to exceed 2.5 percent of the total payments estimated for a given year.

Among the proposals that could help lower payments is a proposal to pull two hypertension codes, 401.9 and 401.1, from the case-mix list. CMS is also proposing far more specific, and restrictive language regarding therapy. The proposals include clarifications on the roles and duties of therapists and assistant, specifics on therapy for rehabilitation or maintenance that moves toward written goals, that all therapy visits must be considered reasonable and necessary, and what constitutes assessment, documentation and goals.

“The new HH PPS provisions will help ensure more accurate payments under Medicare and reflect prudent financial stewardship of the Medicare Trust Fund,” said Jonathan Blum, director of the Center for Medicare and deputy administrator for CMS.

In CY 2010, CMS finalized a policy that requires HHAs that change ownership within three years of initial enrollment to obtain a new State survey or accreditation.  CMS now proposes exceptions to the 36-month provision for certain types of ownership transactions.  CMS is also clarifying the quality reporting requirements for the CY 2012 HH PPS rate update, as it relates to the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey.

Home health payment rates are updated annually by the home health market basket percentage increase.  CMS uses the home health market basket index, which measures (and tracks) inflation in the prices of an appropriate mix of goods and services included in home health services.

Read my post on the HTN case-mix proposal.

Read my post on proposed documentation and therapy roles.

Read about CMS’s specific skilled services wording aimed at reasonable and necessary therapy.

Find out more at www.healthcare.gov.

Read the full proposed rule.

Comments are being accepted until Sept. 14 on this proposed rule, CMS-1510-P. To send comments, go to http://www.regulations.gov.  Follow the instructions under the “More Search Options” tab.

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