CMS Issues Medicare Home Health Proposed Rule

CMS has issued the proposed rule regarding 2013 payment rates, which reflect an inflation update and case mix creep adjustment, policy changes on non-compliance sanctions and clarifications and improvements on face-to-face and therapy assessment rules.

Here are some of the key points of the proposed rule:

Market Basket Index & Payment Rates
Proposed 2013 payment base episode rates are set at $2,141.95, up from the current $2,138.52. While only a small increase, it is not the decrease that could have been if CMS included a full creep adjustment. The base rates are adjusted up by 3% for services to rural patients. Rates are adjusted down by 2% for providers that failed to submit compliant quality data.

The rate changes are due to a proposed 2.5% market basket index inflation update, a 1 point reduction in the MBI under the health care reform law and a 1.32% case mix creep adjustment left over from the 2012 rate rule.

CMS originally proposed a 5.06% adjustment in 2012, but ultimately decided to phase it in over two years with 1.32 percent left for 2013.

Face-To-Face Requirement
The proposed rule included revisions to home health face-to-face requirements that will provide some relief to home health agencies, including the proposal to revise regulatory language that led to a requirement that the titling of F2F encounter documentation be completed by the certifying physician.

Under the current regulation, home health agencies continue to struggle to identify ways to ensure that physicians title F2F documentation, such as clinical notes, referrals and discharge plans. This requires returning documentation to already overburdened physicians with a request to affix a title. In the proposed rule, CMS explained that its intent was that the face-to-face documentation be clearly titled, but not necessarily by the certifying physician. In order to affect the needed change, CMS is proposing to amend regulatory language to: "The documentation of the face-to-face patient encounter must be a separate and distinct section of, or an addendum to, the certification, and must be clearly titled and dated and the certification must be signed by the certifying physician."

In addition, the home health industry asked whether it would be acceptable for an allowed non-physician practitioner (NPP) working in collaboration with an acute or post-acute facility physician to perform the face-to-face encounter and communicate his or her clinical findings to the acute or post-acute care physician who would then communicate them to the certifying physician in the community.

In response to this request CMS has proposed that, for patients admitted to home health from an acute or post-acute facility, they will modify the regulations to allow an NPP working in collaboration with or under the supervision of an acute or post-acute inpatient physician to perform the face-to-face encounter, and allow that inpatient physician to inform the certifying physician in the community of the patient's homebound status and need for skilled services.

Hospice Quality Reporting
In the proposed rule, CMS indicates it does not intend to expand hospice quality data collection requirements for calendar year 2013 beyond those items being collected during the final calendar quarter of 2012, which include pain management and having a Quality Assessment & Performance Improvement program.

It also provides additional information about the pilot it currently has under way to test a hospice patient data set. CMS has indicated that it does not intend to move to public reporting of hospice quality indicators until it has developed a standardized data set. The data set may be implemented in 2014. It also lists the quality measures it is considering for future hospice quality reporting, which include five National Quality Forum (NQF)-endorsed measures, such as dyspnea screening and treatment and pain screening and assessment, and the NQF-endorsed measure from the Family Evaluation of Hospice Care (FEHC), which is NQF 0208, in addition to the existing NQF 0209 and the structural measure. CMS indicates that it is considering an experience of care survey (such as the FEHC) but it does not envision implementation of both a data set and an experience of care survey in the same year and would project implementation in succession in order to avoid excessive burden to hospices

Therapy Assessment Rule
CMS proposes to revise the regulations to state that if a qualified therapist missed a reassessment visit, therapy coverage would resume with the visit during which the qualified therapist completed the late reassessment, not the visit after the therapist completed late reassessment.

It also proposes to revise the regulation to state that in cases where multiple therapy disciplines are involved, if the required reassessment visit was missed for any one of the therapy disciplines for which therapy services were being provided, therapy coverage would cease only for that particular therapy discipline. Therefore, as long as the required therapy reassessments were completed timely for the remaining therapy disciplines, therapy services would continue to be covered for those therapy disciplines.

Finally, with respect to the therapy assessments timing, CMS proposes to revise the regulations to clarify that in cases where the patient is receiving more than one type of therapy, qualified therapists could complete their reassessment visits during the 11th, 12th or 13th visit for the required 13th visit reassessment and the 17th, 18t, or 19th visit for the required 19th visit reassessment.

Click here to view the proposed rule. PHA will be submitting comments on the proposed rule. Members are encouraged to provide comments and feedback by no later than Aug. 28 to Eric Kiehl, PHA Public Affairs Director, at ekiehl@pahomecare.org.

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