Payment changes proposed for 2011
Payment changes proposed by the Centers for Medicare & Medicaid Services (CMS) represent a 4.75% decrease in Medicare payments to home health agencies (HHAs) for calendar year (CY) 2011. This is an estimated net decrease of $900 million compared to payments HHAs received in CY 2010. It includes the combined effects of a market basket update, a wage index update, reductions to the home health prospective payment system (HH PPS) rates to account for increases in aggregate case-mix that are unrelated to underlying changes in patients' health status, and other provisions mandated by the Affordable Care Act (ACA) of 2010.
The ACA mandates that CMS apply a 1% point reduction to the CY 2011 home health market basket amount, which equates to a proposed 1.4% update for HHAs in CY 2011. CMS also proposes to further reduce HH PPS rates in CY 2011 to account for additional growth in aggregate case-mix that is unrelated to changes in patients' health status. Based on updated data analysis, instead of the planned 2.71% reduction for CY 2011, CMS proposes to reduce HH PPS rates by 3.79% in CY 2011 and an additional 3.79% in CY 2012.
The ACA also changes the existing home health outlier policy through a 5% reduction to HH PPS rates, with total outlier payments not to exceed 2.5% of the total payments estimated for a given year. HHAs are also permanently subject to a 10% agency-level cap on outlier payments.
The proposed rule also offers an approach to implement an ACA provision, which mandates that, prior to certifying a patient's eligibility for the Medicare home health benefit, the physician must document that the physician or a non-physician practitioner has had a face-to-face encounter with the patient.
Payment changes proposed by the Centers for Medicare & Medicaid Services (CMS) represent a 4.75% decrease in Medicare payments to home health agencies (HHAs) for calendar year (CY) 2011.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
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