CMS Proposes $375M Cut to Medicare Home Health Payments

RevCycleIntelligence | By Jacqueline LaPointe
 
CMS has released the calendar year (CY) 2024 Home Health Prospective Payment System (HH PPS) Rate Update proposed rule, which includes a 2.2 percent, or $375 million, cut to Medicare home health payments.
 
The federal agency said in the HH PPS Rate Update proposed rule that the payment cut reflects a 2.7 percent increase — approximately $460 million —  less a 5.1 percent statutory decrease. The decrease reflects the impacts of a proposed prospective, permanent behavior assumption adjustment ($870 million decrease) and an estimated 0.2 percent increase that reflects the impacts of a proposed update to the fixed-dollar loss ratio (FDL) for outlier payments determinations ($35 million increase).
 
“This rule proposes a permanent, prospective adjustment to the CY 2024 home health payment rate to account for the impact of the implementation of the Patient-Driven Groupings Model (PDGM),” CMS wrote. “This adjustment accounts for differences between assumed behavior changes and actual behavior changes on estimated aggregate expenditures due to the implementation of the PDGM and 30-day unit of payment as required by the Bipartisan Budget Act of 2018, which amended section 1895(b) of the Social Security Act (the Act).”
 
The federal agency had previously finalized a permanent adjustment following PDGM implementation, but the adjustment was half of the estimated required permanent adjustment, according to the latest proposed rule.
 
The HH PPS has undergone reform since the Bipartisan Budget Act of 2018 required CMS to “better align payment with patient care needs and to better ensure that clinically complex and ill beneficiaries have adequate access to home health care.” The PDGM became effective in 2020 and uses 30-day periods as a basis for payment that are adjusted based on case-mix groups.
 
By law, CMS has had to make assumptions about behavior changes that could occur because of the implementation of the 30-day unit of payment. CMS finalized three behavior assumptions around clinical group coding, comorbidity coding, and low utilization payment adjustment (LUPA) threshold.
 
The CY 2024 HH PPS Rate Update proposed rule continues to implement a permanent adjustment to Medicare home health payments as a result of the assumed behavior changes and how home health agencies actually performed in CYs 2020 and 2021. But the rule said Medicare paid more under PDGM and the 30-day periods than it would have under the old system based on a CY 2022 claims analysis, resulting in a larger permanent adjustment.
 
The proposed permanent adjustment includes the remaining -3.925 percent to account for CYs 2020 and 2021, which were not applied to the CY 2023 payment rate, and accounts for actual behavior changes in CY 2022.
 
CMS also said in the rule that it plans to adopt a 2021-based home health market basket and will recalibrate the 432 payment groups under PDGM using CY 2022 data…

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Guidebook of Policies and Procedures for Pre-Rulemaking Measure Review (PRMR) and Measure Set Review (MSR)

The Guidebook of Policies and Procedures for Pre-Rulemaking Measure Review (PRMR) and Measure Set Review (MSR) is now available for public comment.  The Guidebook was developed as part of a CMS-funded contract, the National Consensus Development for Strategic Planning and Healthcare Quality Measurement. It provides an overview of the PRMR (previously conducted via the Measure Applications Partnership) and MSR policies and procedures, associated timelines, measure selection and removal criteria, a summary of the committee compositions, and how committees will be engaged. We will host an informational session on July 10th 2-4 pm EST to discuss the Guidebook prior to closing the public comment period. You can register here.

Please submit comments by visiting the Partnership for Quality Measurement website.

Public comment will remain open for 30 days, closing at 11:59 PM ET on July 21. If you have any questions about the comment submission process, please contact [email protected].
 

National, State-Level, and County-Level Prevalence Estimates of Adults Aged ≥18 Years Self-Reporting a Lifetime Diagnosis of Depression — United States, 2020

Weekly / June 16, 2023 / 72(24);644–650

Benjamin Lee, MPH1,2; Yan Wang, PhD1; Susan A. Carlson, PhD1; Kurt J. Greenlund, PhD1; Hua Lu, MS1; Yong Liu, MD1; Janet B. Croft, PhD1; Paul I. Eke, PhD1; Machell Town, PhD1; Craig W. Thomas, PhD1 (VIEW AUTHOR AFFILIATIONS)

Summary

What is already known about this topic?

Depression is a major cause of morbidity and mortality in the United States.

What is added by this report?

During 2020, 18.4% of U.S. adults reported having ever been diagnosed with depression; state-level age-standardized estimates ranged from 12.7% in Hawaii to 27.5% in West Virginia. Model-based age-standardized county-level prevalence estimates ranged from 10.7% to 31.9%, and there was considerable state-level and county-level variability.

What are implications for public health practice?

Decision-makers can use these estimates to guide resource allocation to areas where the need is greatest, possibly by implementing practices such as those recommended by The Guide to Community Preventive Services Task Force and the Substance Abuse and Mental Health Services Administration.

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First-Ever Exercise Guidelines for RA Treatment Emphasize Physical Therapy

APTA

Several APTA members helped create the new guidance on how best to integrate exercise, diet, and other elements into RA management.

The Message

In its first-ever set of guidelines for the use of interventions beyond antirheumatic drugs in the treatment of rheumatoid arthritis, the American College of Rheumatology strongly recommends consistent engagement in exercise and emphasizes the role of physical therapists and occupational therapists in what it believes should be a multidisciplinary treatment team.

Authors say that while more research is needed to identify which types of exercise and rehabilitation approaches are most effective, that only underscores the importance of knowledgeable therapists working with patients to identify the kinds of exercises and treatments that are best suited to the patient's own needs and goals. Additional recommendations offer guidance related to diet, cognitive behavioral therapy, acupuncture, thermal modalities, and more.

The Study

Development of the guideline began with the establishment of a set of clinical population, intervention, comparator, and outcome questions, which were the basis for a systematic review of the research literature. That team gathered relevant research, evaluated the quality of evidence, and presented an initial report that was reviewed by additional guideline team members as well as a panel of 12 patients with RA. The patient panel added its perspectives and preferences to the review, which was presented to a voting panel. That panel had to reach agreement of 70% or more of panel members in order to arrive at a recommendation as well as establish a level of evidence to support the recommendation. Three members of the patient panel served on the voting panel.

The initial review identified nearly 9,000 potentially eligible manuscripts, which were winnowed to 275 that met criteria for use in guideline development.

APTA members Anita Bemis-Dougherty, PT, DPT, MAS; Thomas Bye, PT, DPT, MS; Chris Lane PT, DPT; Hiral Master, PT, MPT, PhD, MPH; Carol Oatis, PT, PhD; Daniel Pinto, PT, PhD; Kimberly Steinbarger, PT, MSPT, DHSc, MHS; Louise Thoma, PT, PhD; and Daniel White, PT, ScD, MSc, participated in the development of the guideline. Oatis, Thoma, and White were among the authors of an accompanying editorial.

Recommendations and Evidence Strength

The recommendations are presented in four broad areas: exercise, rehabilitation, diet, and "additional integrative intervention recommendations." Recommendations are identified as either "strong" or "conditional" and include guidance both for and against various interventions. Only engagement in exercise was supported by moderate evidence strength, the single highest strength rating given in this resource. The remaining recommendations were supported by low- to very low-certainty evidence, or were not supported by evidence but were identified by the voting panel as important to include in the guideline.

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We Need to Hear from Your Patients!

APTA Colorado intends to introduce legislation to lessen the negative impact that insurance carriers and their 3rd party intermediaries have on you, your patients and your employers. We need to hear from your patients to show legislators that we have a problem with utilization management and prior authorization to justify our legislative recommendations. Please ask your patients with private insurance or Medicaid to complete this 1-2 minute survey to help our profession fight back against insurance carrier overreach. Survey Link: https://4c50zwuoahq.typeform.com/to/lVqBipfX
 
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