The Centers for Medicare & Medicaid Services issued a proposed rule Tuesday that would reduce Medicare payments to home health agencies by $58 million next year and hinted at changes to come.
The impact of a 2.2 percent ($427 million) increase in payments to home health agencies would be undercut by a $485 million decrease through adjustments to the 60-day episode rate (as mandated by the Affordable Care Act), the per-visit payment rates and the non-routine medical supplies conversion factor.
The rule also proposes changes to the requirement that providers must meet face-to-face with beneficiaries before beneficiaries can receive the home health benefit.
CMS' proposal retains the face-to-face encounter but eliminates the narrative requirement. The agency also proposes that only medical records from patients' physicians or discharging facilities will determine initial eligibility for home health benefits and the physician claim (rather than the face-to-face encounter) for certification or re-certification of eligibility for home health benefits will be considered a non-covered service if the home health agency claim was non-covered because of patient ineligibility.
CMS also noted that it is considering testing a value-based purchasing model for home health agencies beginning in 2016. The potential VBP model for home health would, like the model for hospitals, tie payments to quality of care. With each subsequent planned performance period, the percentage of payment would increasingly be tied to quality of care. CMS is considering a 5 percent to 8 percent payment adjustment scale.
The agency plans on testing the home health VBP model in five to eight states and is asking for comment. Such a model, the agency said in a press release, "… presents an opportunity to test whether significantly larger incentives would lead to higher quality of care for beneficiaries."