In the News

Dissecting the 2023 Home Health Final Rule: Several Articles to Help

The following articles help to bring additional perspective to the home health final rule and bring attention to things to look out for besides the pending rate cuts. Also see the downloadable resources included at the end of this section. 

NAHC President: CMS Was Tactical, Strategic In How Final Rule Was Announced
Home Health Care News | By Patrick Filbin

By walking back severe cuts initially proposed in the home health payment rule, the U.S. Centers for Medicare & Medicaid Services (CMS) was strategically trying to create positive feelings about the final rule in order to have an upper hand down the line.

That is the assessment made by William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), less than a week removed the final rule’s publishing.

“It’s important to understand some of the politics of what happened in this final rule,” Dombi said during a NAHC webinar Friday. “CMS went with a headline saying they were cutting over $800 million — in one year alone — from home health care spending to a headline that now says they’re increasing spending by $125 billion. That was a strategic, tactical move by CMS to put out a positive headline.”

That messaging, Dombi said, has helped CMS initially convince Congress that lawmakers may not have to make any additional changes.

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From HHVBP to LUPAs: Additional Takeaways From The 2023 Home Health Final Rule
Home Health Care News | By Patrick Filbin

Following the Centers for Medicare & Medicaid Services’ (CMS) release of the final payment rule, it is critical for each home health agency to figure out its own financial standing and strategic plan for 2023. 

In addition, agencies should be finding key areas for improvement and educating clinicians on the recalibrated case-mix weights and Low-Utilization Payment Adjustment (LUPA) thresholds.

Those suggestions came during a Thursday webinar with experts with the home health consulting firm SimiTree.

“Each agency is going to be different in terms of what the financial impacts are going to be,” Nick Seabrook, managing principal at SimiTree, said. “The LUPA threshold going down is going to be a pretty significant change to agencies and that could move the needle pretty significantly from a revenue standpoint as well. It’s important to know what the impact of this is for your agency.”

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What Home Health Providers May Change Due To Final Rule
Home Health Care News | By Andrew Donlan

Now that the final payment rule for the home health care industry is officially out, providers and advocates will take the long-awaited next step.

For advocates, that will mean continuing legislation efforts. Although the final rule includes a 0.7% aggregate payment bump for home health agencies, behavioral adjustment cuts are still being implemented. That’s a phased-in approach that the Centers for Medicare & Medicaid Services (CMS) would like to continue in coming years. 

“We now turn to Congress to correct what CMS has done and prevent the impending harm to the 3.2 million highly vulnerable home health patients that depend on this essential Medicare benefit annually,” National Association for Home Care & Hospice (NAHC) President William A. Dombi said in a statement shared with Home Health Care News Monday. “Even with the limited phase-in of the rate cut, with significantly rising costs for staff, transportation, and more, home health agencies across the country cannot withstand the impact of rate cuts.”...

...There will still be margin pressures due to the final rule – and final rules for future years – if the Preserving Access to Home Health Act does not gain any more traction in Washington, D.C. That piece of legislation would curb any cuts to home health reimbursement until 2026.

And if the margins are not there, less investment in other service lines is almost a certainty. But what may actually tick up is investment in technology in order to increase efficiency in certain areas.

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HH Final Rule 7.85% Rate Cut: Advocacy 1-Pager

HH Final Rule Federal Health Policy Strategies Analysis


Calendar Year (CY) 2023 Medicare Physician Fee Schedule Released

The Centers for Medicare & Medicaid Services (CMS) has finalized changes in CMS’s annual Physician Fee Schedule (PFS) proposed rule to significantly expand access to behavioral health services and moves the health system closer to achieving equitable outcomes through high quality, affordable, person-centered care. These changes will ensure CMS continues to deliver on our goals of advancing health equity, driving accountable care, and protecting the sustainability of the Medicare program.

Building on the CMS Innovation Center’s successful ACO Investment Model (AIM), CMS is changing the Medicare Shared Savings Program to make more Accountable Care Organizations (ACOs) available in rural and underserved areas, which builds upon our continuing efforts to advance health equity. We are launching a payment adjustment for ACOs that reward them when they provide excellent care to underserved populations.

The Innovation Center also sought comment on an alternative approach to calculating ACO historical benchmarks that would use administratively set benchmarks that are decoupled from ongoing observed FFS spending including the design of the approach, as described in the Request for Information (RFI). CMS has observed that the benchmarking methodology for the Shared Savings Program and Innovation Center models may include ratchet effects that reduce benchmarks for successful ACOs and jeopardize their continued participation over multiple agreement periods, resulting in selective participation (including limited participation by inefficient ACOs). The RFI gathered information regarding the future use of administrative benchmarking, and comments will be considered for future rulemaking.

For more information, please see the PFS press release.


Where to Start? Foundational Learning Materials for the Expanded HHVBP Model

Leading up to CY 2023, the HHVBP TA Team will spotlight different introductory resources to guide HHAs in preparing for the first performance year of the expanded HHVBP Model. CMS and the TA Team encourage HHA staff to review the following resources available on the Expanded HHVBP Model webpage:

  • HHVBP Model Expansion 101 Live Event – In February 2022, the HHVBP TA Team hosted a live learning event: HHVBP Model Expansion 101. The team shared essential information regarding the expanded HHVBP Model, including topics such as participation criteria, cohort assignment, quality measures, payment adjustment methodology, and performance feedback reports. The learning event concluded with a live Q&A session.
  • Expanded HHVBP Model Frequently Asked Questions (FAQs) – Routinely updated, the FAQs assist HHAs in understanding common terms used in the expanded HHVBP Model and requirements under the CY 2022 Home Health Prospective Payment System (HH PPS) final rule. The HHVBP TA team provides updates to the FAQs as needed and notifies HHAs that have signed up to receive communications when an updated version is available on the Expanded HHVBP Model webpage.
  • Expanded HHVBP Model Guide – The Model Guide includes an overview of the expanded Model, information on eligibility and cohorts, quality measures used in the expanded Model, Total Performance Score (TPS) methodology and payment adjustment methodologies, and an overview of the performance feedback reports.

If you have questions about implementation of the expanded HHVBP Model, please email the HHVBP Help Desk at [email protected]com


Telehealth Home Health Services: New G-Codes

In the CY 2019 HH Prospective Payment System (HH PPS) final rule with comment (83 FR 56406), we finalized the definition of remote patient monitoring in regulations at 42 CFR 409.46(e) as the collection of physiologic data (electrocardiogram, blood pressure, glucose monitoring) digitally stored or transmitted by the patient or caregiver to the HHA.

The first COVID–19 Public Health Emergency (PHE) interim final rule with comment period (IFC) (85 FR 19230) implemented additional policies under the HH PPS to make providing and receiving services via telecommunications technology easier.

The plan of care must describe how such technology is tied to the patient-specific needs in the comprehensive assessment.

The amended plan of care requirements in 42 CFR 409.43(a) also state that these services can’t substitute for a home visit ordered as part of the plan of care. Also, they can’t be considered a home visit for the purposes of patient eligibility or payment, per section 1895(e)(1)(A) and (B) of the Social Security Act. The CY 2021 HH PPS final rule with comment period (85 FR 70298) finalized these changes on a permanent basis. It also amended 42 CFR 409.46(e) to include not only remote patient monitoring, but other communication or monitoring services consistent with the plan of care for the individual, on the HH cost report as allowable administrative costs.

Today, data collection on telecommunications technology use is limited to overall cost data on a broad category of telecommunications services as a part of an HHA’s administrative costs on line 5 of the HHA Medicare cost reports. Data on telecommunications technology use during a 30-day period of care at the patient level isn’t currently collected on the HH claim. While the provision of services provided via a telecommunications system must be in the patient’s plan of care, CMS doesn’t routinely review plans of care to determine the extent these services are actually provided.

Collecting data on telecommunications technology use on HH claims will allow us to:

• Analyze the characteristics of patients using services provided remotely

• Have a broader understanding of the social determinants that affect who benefits most from these services, including what barriers may potentially exist for certain subsets of patients

Starting on or after January 1, 2023, you may voluntarily report the use of telecommunications technology in providing HH services on HH payment claims. We’ll require this information on HH claims starting on July 1, 2023. You’ll submit the use of telecommunications technology on the HH claim using the following 3 G-codes:

• G0320: Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system

• G0321: Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system

• G0322: The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (for example, remote patient monitoring)

Report the use of remote patient monitoring that spans a number of days as a single line item showing the start date of monitoring and the number of days of monitoring in the units field. You’ll submit services provided via telecommunications technology in line-item detail. Report each service as a separate dated line under the appropriate revenue code for each discipline providing the service. You must document the medical record to show how the telecommunications technology helps to achieve the goals outlined on the plan of care.

You can only report the above 3 G-codes on Type of Bill 032x. You should only report these codes with revenue codes 042x, 043x, 044x, 055x, 056x, and 057x.

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