The Trump administration on Thursday finalized a 1.3% pay bump next year for home health agencies and created a new home infusion therapy benefit.
The $250 million raise is the same as initially proposed in July. Separately, the CMS increased payments for home health agencies participating in the Patient-Driven Groupings Model. They will receive 4% more in their 30-day payments than earlier suggested.
The rule creates a new home infusion therapy benefit to take effect in 2021. Home infusion therapy is the administration of certain medications, such as chemotherapy, using a pump in a patient's home. The benefit includes professional services, patient education and training and monitoring patient care.
While the agency touted the new benefit as allowing patients to choose where they receive care, some stakeholders say the policy may force more patients into hospitals because it would pay infusion drug suppliers only for days when a skilled provider is present to administer the therapies to patients.
"CMS continues to misconstrue how home infusion services are provided by restricting payment to when a skilled professional is in the patient's home," Premier said in a statement. "CMS' policy runs counter to congressional intent clearly articulated in the 21st Century Cures Act and Bipartisan Budget Act of 2018 and is contrary to the administration's goals of decreasing healthcare spending and rewarding value over volume."
The CMS is also finalizing a policy to allows therapist assistants, and not just therapists, to perform maintenance therapy under the Medicare home health benefit. The agency also said it will phase out pre-payments for home health services over the next year and eliminate them completely in 2021 to address potential fraud.
In a separate rule, the CMS finalized payment rates for its end-stage renal disease prospective payment system, giving providers a 1.7% bump.
Medicare expects to pay about $10.3 billion to 7,000 end-stage renal disease facilities for the costs associated with furnishing renal dialysis services under the prospective payment system in 2020, the agency said.
The CMS also finalized policies that it said would spur more innovation in kidney care. Under the rule, certain new and innovative equipment and supplies used to care for a kidney disease patient will qualify for a transitional add-on payment adjustment, creating incentives for facilities to provide innovative therapies to improve health outcomes.
The agency further updated the acute kidney injury dialysis payment rate, refined the way it pays for new kidney-related drugs to encourage uptake of the latest therapies, and finalized several programmatic updates to its End-Stage Renal Disease Quality Incentive Program for 2022 and later.
In the same rule, the agency also finalized a policy to promote competition and innovation in Durable Medical Equipment Prosthetics, Orthotics, and Supplies by setting Medicare payment for certain new items based on commercial pricing data.
It is also streamlining the requirements for ordering durable medical equipment and developing a single list of items subject to payment requirements, such as a face-to-face examination or prior authorization. The rule also creates a standardized set of required elements for ordering a DMEPOS item.
"CMS believes streamlining requirements furthers the CMS' efforts to reduce fraud, waste, and abuse by promoting a better understanding of Medicare DMEPOS conditions of payment, which may result in increased compliance," the agency said in a fact sheet.
