On July 11, 2019, the Centers for Medicare and Medicaid Services (“CMS”) announced a proposed rule for home health agency Medicare reimbursement that would increase payments by an aggregate 1.3% for 2020, amounting to $250 million. In doing so, CMS would begin a transition to payments that are value-based, implementing the Patient-Driven Groupings Model (“PDGM”), an alternate case-mix payment methodology. In the PDGM, home health agencies are paid for 30 rather than 60-day episodes of care, and reimbursement is based on patient characteristics rather than the number of therapy visits provided. In a statement from CMS administrator Seema Verma regarding the proposed rule, she said the PDGM will reward “value over volume.” The proposed changes to reimbursement also include a one-year phasing out of pre-payments for home health services, known as Requests for Anticipated Payment. These proposed changes reflect a significant shift in the manner in which home health agencies historically have been reimbursed.

The rule, if finalized, would also create a permanent home infusion therapy benefit in 2021, allowing beneficiaries to receive critical infusion drug therapies in their homes through the use of durable medical equipment. In her statement, Verma said the benefit “will give patients the freedom to safely access critical treatments, such as chemotherapy, at home instead of traveling to the hospital or doctor’s office, improving their quality of life.” CMS proposes grouping home infusion drugs into three payment categories, each with a single unit of payment in accordance with specified infusion codes and units, to allow providers and suppliers sufficient time to prepare for the implementation of the benefit.

Other proposed changes include adding two quality measures that assess the transfer of health information to the Home Health Quality Reporting Program (“HH QRP”), adopting standardized patient assessment data elements (“SPADEs”), removing the Improvement in Pain Interfering with Activity Measure from the HH QRP, publicly reporting Home Health Value-Based Purchasing Model performance data, and allowing therapist assistants to furnish maintenance therapy to patients in their homes under the Medicare home health benefit.

CMS will accept comments on the proposed rule through September 9, 2019.