CMS on Monday proposed expanding its home health value-based purchasing program nationwide.
The CMS Innovation Center first tested the model in January 2016. The program shifts paying for Medicare home health services based on volume to a system that pays for value and quality. Currently, all Medicare-certified home health agencies in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee and Washington participate in the program.
In the third evaluation report on the program, participants showed an average 4.6% improvement on quality scores and an average annual savings of $141 million to Medicare from 2016-2018, CMS said. The agency in January said it planned to expand the model no later than Jan. 1, 2022.
"Homebound Medicare patients face a unique set of challenges and barriers to getting the care they need," CMS Administrator Chiquita Brooks-LaSure said in a statement. "Today's announcement is a reaffirmation of our commitment to these older adults and people with disabilities who are counting on Medicare for the health care they need. This proposed rule would streamline service delivery and value quality over quantity – at a time when Americans need it most."
CMS also proposed making permanent some changes to home health implemented during the COVID-19 pandemic.
The proposed rule would allow aides to conduct 14-day supervisory visits for patients receiving skilled services via telehealth. CMS still recommends that most visits take place during an on-site, in-person visit, and that the home health agency aide would only use telecommunications if something unexpected interrupted scheduled in-person visits.
"We believe the current 14-day on-site supervisory visit requirement when a patient is receiving skilled services is an important component to assessing the quality of care and services provided by the (home health) aide, and to ensure that aide services are meeting the patient's needs," CMS wrote.
CMS proposed permanently allowing occupational therapists to make initial assessment visits when occupational therapy is part of the home health care plan with either physical therapy or speech therapy, and skilled nursing services are not initially part of the plan of care, CMS said.
Additionally, the rule asks for feedback on how to achi]eve health equity for all patients through policy solutions, CMS said.
Under the rule, CMS would also assess a two-percentage point reduction in the annual update of any home health agency that doesn't meet home health quality reporting requirements.
