The CMS issued a proposed rule this week that would boost payment rates for home health agencies in 2020 and continue implementing several changes to the way it pays for the services they provide. The rule also includes proposals for a permanent home infusion therapy benefit to take effect in 2021.
The agency estimated that the proposed policies will increase payments to home health agencies by 1.3%, or $250 million, in 2020.
"We are proud to announce the new permanent home infusion therapy benefit that will give patients the freedom to safely access critical treatments, such as chemotherapy, at home instead of traveling to the hospital or doctor's office, improving their quality of life," CMS Administrator Seema Verma said in a statement.
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.
To give providers and suppliers enough time to implement that new benefit, the CMS proposed grouping the home infusion drugs into three payment categories, each with a single unit of payment with specified codes. It also proposed a higher payment amount for the first home infusion therapy visit and small decreases in payments for subsequent visits in order to make the payment adjustments budget-neutral.
The CMS also proposed allowing therapist assistants to provide maintenance care under the Medicare home health benefit, which will free up other providers to spend time improving health outcomes for patients, it said.
The proposed rule would also continue implementing a new pay model for home health services called for under the Bipartisan Budget Act of 2018 and finalized in a previous rule. Under the new pay model, called the Patient-Driven Groupings Model, it would pay health agencies for 30-day episodes of care, rather than the current system's 60-day periods. It would also eliminate the use of therapy thresholds to adjust payment.
The new pay model is meant to shift the focus from the volume of services provided to one that relies on patient characteristics, according to the proposed rule.
The CMS also said it will phase out pre-payments for home health services. It said the change should mitigate potential fraud and reduce the amount of paperwork required of providers. Finally, the proposed rule modifies the quality measures under the home health quality reporting program.
