CMS Home Health Final Rule Pushes Modernization and Value-Based Care

The new rules, which focus on the 2019 and 2020 calendar years, update payment regulations, support expansion of remote patient monitoring, and seek to ease regulatory burdens.

The Centers for Medicare & Medicaid Services (CMS) are updating payment and innovation rules for home health.

As home health agencies expand and health systems establish more robust capabilities for post-acute care including home health services, a CMS final rule announced last week finalizes calendar year 2019 and 2020 payment and policy changes, including regulations to promote remote patient monitoring and ease regulatory burdens.

"[The final] rule overhauls how Medicare pays for home health, refocusing on the needs of patients, promoting innovation, and reducing burden for physicians and home health providers," CMS Administrator Seema Verma said in a prepared statement.

Medicare payment
 

Medicare payments to home health agencies in calendar year 2019 are estimated to increase 2.2%, or $420 million, based on the agency's finalized policies, according to a CMS fact sheet.

A rule change that eases operations for home health agencies as well as health systems and hospitals that offer home health services speeds Medicare payments.

The rule change under the Home Health Prospective Payment System alters the unit of payment under HHPPS from 60-day episodes of care to 30-day episodes of care. The change is set to be implemented on Jan. 1, 2020.

Another new payment regulation slated to start on Jan. 1, 2020, is designed for Medicare to pay for value rather than volume of services. Under this change, Medicare will discontinue the practice of determining home health payments based on the number of visits provided. Instead, a patient's medical condition and care needs will be the determinative factors.

"Therapy thresholds encourage volume over value and do not acknowledge that all patients are not the same, with some patients having complex needs that do not involve a lot of therapy," the CMS fact sheet says.

Remote patient monitoring
 

The final rule sets a new definition for remote patient monitoring and makes it easier to receive Medicare payment for the service.

The final rule states remote patient monitoring can be a beneficial service in the home-health setting.

"Fluctuating or abnormal vital signs could be monitored between visits, potentially leading to quicker interventions and updates to the treatment plan. Additionally, … remote patient monitoring may improve patients' ability to maintain independence, improving their quality of life," the final rule says.

Some patients garner major health benefits from remote monitoring, the final rule says. "Particularly for patients with chronic obstructive pulmonary disease and congestive heart failure, research indicates that remote patient monitoring has been successful in reducing readmissions and long-term acute care utilization. Other benefits included fewer complications and decreased costs."

The final rule's new definition of remote patient monitoring is relatively succinct: "The collection of physiologic data—for example, ECG, blood pressure, glucose monitoring—digitally stored and/or transmitted by the patient or caregiver or both to the home health agency."

Under the final rule, remote patient monitoring is billable to Medicare as an administrative cost.

Regulatory burden reduction
 

Reducing bureaucratic costs is a central theme of the final rule.

For example, CMS is ending a requirement that certifying physicians estimate how long home-health services are needed. "This policy is responsive to industry concerns about regulatory burden reduction and could reduce claims denials that solely result from an estimation missing from the recertification statement," the CMS fact sheet says. 

For calendar year 2019, CMS estimates this rule change will generate $14.2 million in cost savings for certifying physicians.