CMS Releases PPS Rate Update for Certified Home Health Agencies

Posted on November 4, 2020 by Bobbie Guidry

Last week, CMS released the final CY2021 Home Health Prospective Payment System Rate Update rule. The final rule includes updates of interest to Medicare Certified Home Health Agencies. The rule:

• Updates the payment rates for home health agencies by 2% for 2021;
• Adopts the new OMB statistical area delineations while capping wage index decreases at 5% for 2021 which is consistent with CMS policy across the Medicare program;
• Holds LUPA thresholds, case-mix weights, and behavior assumptions at the same levels as CY2020;
• Finalizes the changes to §409.43(a) as implemented in the March 2020 IFC that states that the plan of care can and must include any provision of services furnished via telecommunications systems. The rule reiterates that visits via a telecommunications system cannot substitute for a home visit ordered as part of the plan of care and cannot count as a home visit for purposes of eligibility or payment. This is a good reminder for members to: Send an action alert to Capitol Hill about the HEAT Act which would allow for payment for telecommunications visits during a public health emergency.
• The rule also discusses the new home infusion benefit, reporting on the Home Health Value Based Purchasing Program, and changes to the Conditions of Participation OASIS requirements.