Home health agencies could see a 3.35% Medicare payment cut in 2012 (PDF) if a proposed rule CMS issued Tuesday is made final.
CMS proposes home health payment cut
The CMS estimates the cut would result in a decrease of about $640 million compared with Medicare payments to the nation’s home health agencies in fiscal 2011. According to the agency, these changes include the combined effects of market basket and wage updates that amount to an increase of $310 million with a 5.06% reduction in the home health prospective payment system rate. That reduction, the CMS said, is meant to account for the increase in the home health case-mix that is unrelated to patient acuity.
The regulation also proposes to remove two hypertension codes from the case-mix system; lower payments for high-therapy episodes; and also recalibrate the home health PPS case-mix weights to make sure these changes result in the same amount of total aggregate payments.
Meanwhile, current Medicare policy requires that a certifying physician or an allowed nonphysician practitioner must see a patient before certifying that patient as eligible for the home health benefit. In the proposed rule Tuesday, the CMS allowed physicians who attended to patients in an acute or post-acute setting to inform the certifying physician of those encounters in order to fulfill that requirement.
In a separate proposed rule, the CMS said it would revise the Medicaid home health service definition (PDF) in the healthcare reform law to add a requirement that physicians document face-to-face encounters with Medicaid beneficiaries—including the use of telehealth—within “reasonable timeframes” that align with the timeframes for Medicare home health services.
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