Home health Medicare payments expected to fall

Medicare payments to home health agencies next year are expected to fall by about 2.3%, or roughly $430 million, the CMS announced after issuing a final rule (PDF) Monday to update the home health prospective payment system rates for 2012.

The changes in the regulation include a 1.4% payment update, as well as a wage index update and case-mix coding adjustment. According to the CMS, the marketbasket for home health agencies in 2012 is equal to 2.4%, and last year's Patient Protection and Affordable Care Act called for a 1 percentage point reduction to that amount—which accounts for the 1.4% payment update to these agencies.

Meanwhile, the rule made final some structural changes to the home health prospective payment system by removing two hypertension codes from the case-mix system, lowering payments for high-therapy episodes and recalibrating the home health PPS case-mix weights in an effort to ensure these changes result in the same amount of total aggregate payments.

And the final rule will allow physicians who cared for a patient in an acute or post-acute facility to inform the certifying physician of their encounters with that patient to qualify the home health benefit. Current policy requires that a certifying physician or an allowed non-physician practitioner must see a patient before certifying a patient to meet that requirement. The rule also outlines some changes to the home health publicly reported quality measures.