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HHA PPS Rates – CY 2012

MLN Matters MM7657 – 11/23/11

This MedLean article provides the details for the PPS rates effective on January 1, 2012.

Final Rules – Home Health PPS rates – CY 2012

CMS-1353-F; FR 11/4/11

CMS News Release

The Centers for Medicare & Medicaid Services (CMS) today issued a final rule to update the Home Health Prospective Payment System (HH PPS) rates for Calendar Year (CY) 2012. Payments to home health agencies (HHAs) are estimated to decrease by approximately 2.31 percent or $430 million in CY 2012, the net effect of a 1.4 percent payment update, the wage index update, and the case-mix coding adjustment.  This final rule reflects the ongoing efforts of CMS to support Medicare beneficiary access to home health services while continuing to improve payment accuracy.  

The Affordable Care Act applies a 1 percentage point reduction to the CY 2012 home health market basket amount.  As the CY 2012 market basket is equal to 2.4 percent, the payment update for HHAs in CY 2012 will be 1.4 percent. 

CMS also reduced HH PPS rates in CY 2012 to account for additional growth in aggregate case-mix that is unrelated to changes in patients’ health status.  CMS has finalized a 3.79 percent reduction to the home health PPS rates for CY 2012 and an additional 1.32 percent reduction for CY 2013. 

This rule also finalizes structural changes to the HH PPS by removing two hypertension codes from the case-mix system, lowering payments for high therapy episodes, and recalibrating the HH PPS case-mix weights to ensure that these changes result in the same amount of total aggregate payments.  These changes are intended to increase payment accuracy and reduce the growth in aggregate case-mix that is unrelated to changes in patients’ health status. 

Under current Medicare policy, a certifying physician or an allowed non-physician practitioner must see a patient prior to certifying a patient as eligible for the home health benefit.  The rule also finalizes added flexibility to allow physicians who cared for the patient in an acute or post-acute facility to inform the certifying physician of their encounters with the patient in order to satisfy the requirement.  Finally, this rule describes planned improvements to the home health publicly reported quality measures.   

CMS 1353-P – FR - 7/12/11

The Medicare HHA proposed rules for calendar 2012 were published in the July 12, 2011 federal register. 

MM7395

MLN Overview:

Because of an error in the calculation of the Home Health Prospective Payment System (HH PPS) 10 percent outlier limitation, the basic calculation of the outlier limitation since January 1, 2010, has been incorrect. As a result, your payment for Medicare home health services in 2010 may be incorrect.