On October 31, 2019, the Centers for Medicare and Medicaid Services (CMS) finalized its 2020 payment and policy changes rule for Home Health Agencies (HHA Rule). The final rule is scheduled to be posted in the Federal Register on November 8, 2019 (see the since published rule), and allows for comments until December 30 in advance of its January 1, 2020, effective date. The HHA Rule makes changes to the Home Health Prospective Payment System (HH PPS), including the implementation of the Patient-Driven Groupings Model (PDGM), and makes other policy changes for home health agencies to the Home Health Value-Based Purchasing (HHVBP) Model and the Home Health Quality Reporting Program (HH QRP). These changes further the shift to a value-based payment system focusing on patient need over volume of care.
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CMS Issues Proposed IPPS Rule
By Robinson+Cole's Health Law Group on
On April 14, 2017, the Centers for Medicare & Medicaid Services (CMS) released the FY 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) Prospective Payment System (PPS) Proposed Rule, and Request for Information (Proposed Rule). The Proposed Rule outlines proposed updates to Medicare payment rates under the Inpatient Prospective Payment System (IPPS) and policies for hospital admissions. The goals of the Proposed Rule include relieving regulatory burdens on providers, supporting the doctor-patient relationship, and promoting transparency, flexibility, and innovation in the delivery of care.
CMS is also soliciting ideas for regulatory, policy, practice and procedural changes to better achieve transparency, flexibility, program simplification and innovation through a Request for Information (RFI). The RFI is seeking clear, concise proposals to encourage the development of a new Medicare delivery system to reduce existing burdens for clinicians, providers and patients, while increasing effectiveness and decreasing costs. Proposals must include data and specific examples, and if applicable, should address CMS’ authority to implement such proposals. CMS does not plan to respond to RFI comments, but will consider them in developing future regulatory proposals or guidance.
The IPPS was established under § 1886(d) of the Social Security Act and utilizes a national base payment rate for inpatient hospital stays, adjusted for factors such as patient conditions and the cost of hospital labor depending on geographic area. CMS is required to issue annual updates for IPPS hospital payment rates. The Proposed Rule would affect hospital and LTCH payments for discharges occurring on or after October 1, 2017.
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