Policymakers say modifications will encourage the use of new technologies by home health agencies and more effective care planning as data is shared by patients, caregivers, and providers.
The Centers for Medicare & Medicaid Services this week proposed an update of the payment model for home healthcare agencies that federal officials say will reward value over volume.
"Today's proposals would give doctors more time to spend with their patients, allow home health agencies to leverage innovation and drive better results for patients," CMS Administrator Seema Verma said Monday in a media release.
"The redesign of the home health payment system encourages value over volume and removes incentives to provide unnecessary care," she said.
Under the proposed rule change, CMS would allow the cost of remote patient monitoring to be reported by home health agencies as allowable costs on the Medicare cost report form.
The system now pays for 60-day episodes of care and relies on the number of therapy visits a patient receives to determine payment. However, the Bipartisan Budget Act of 2018 eliminated the number of therapy visits as a payment factor for home health, beginning in 2020.
The proposed rule would also implement a new Patient-Driven Groupings Model for home health payments that would eliminate the use of "therapy thresholds" to determine payment and changes the unit of payment to 30-day periods of care.
CMS said this modification will encourage the adoption of new technologies by home health agencies and more effective care planning as data is shared among patients, their caregivers, and their providers.
CMS projects that Medicare payments to HHAs in 2019 will increased by 2.1%, or $400 million, based on the proposed policies.
CMS also wants to eliminate the requirement that the physician estimate how much longer skilled services would be needed when recertifying the need for continuing home healthcare, as this information is already gathered on a patient's plan of care.
Verma said the initiative will advance the Administration's MyHealthEData initiative that gives patients ready access to their personal health data.
The Medicare Payment Advisory Commission reports that 3.4 million Medicare beneficiaries received home healthcare in 2016. The program spent about $18.1 billion on home healthcare services that year, and more than 12,200 agencies participated in Medicare.
The CMS proposed rule appears to be in line with a MedPAC recommendation that Medicare eliminated the number of therapy visits as a payment factor. However, that recommendation was made moot when Congress did exactly that under the Budget Act.
"Eliminating the number of therapy visits as a payment factor would base home health payment solely on patient characteristics and result in a more patient-focused approach to payment," MedPAC wrote.
The proposed rule also includes information on the implementation of home infusion therapy temporary transitional payments. In addition, the proposed rule solicits comments on elements of the new home infusion therapy benefit category and proposes standards for home infusion therapy suppliers and accrediting organizations of these suppliers as required by the 21st Century Cures Act.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.