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Delta Connect Blog

CMS Releases Proposed 2015 PPS Rule

Posted by Crystal Parks on Jul 2, 2014 9:45:00 AM


On July 1, CMS issued a proposed rule to update Medicare's Home Health PPS payment rates and wage index for calendar year 2015. Payments to home health agencies are estimated to decrease by approximately 0.30% or -$58 million in 2015.The calculations don't include the 2% sequestration reduction currently in effect through March 2015 for all Medicare providers. 

This proposed rule also proposes changes to: 

  • Simplify the face-to-face encounter regulatory requirements by:
    • Eliminating the requirement that certifying physicians provide a narrative in their own words explaining why the patient is eligible for home health care. The certifying physician would still be required to certify that a face-to-face patient encounter occurred and to document the date of the encounter.
    • Limiting medical reviews to medical records from the patient's certifying physician or from the discharging facility when determining initial eligibility for the home health benefit.
    • Disallowing certification and re-certification claims by physicians when the agency claim is denied on grounds that the patient was ineligible for home health. 
    • Clarifying the face-to-face encounter requirement applies to physician's certification only, not the re-certification of eligibility for subsequent episodes. 
  • Recalibrating case-mix weights using the most current cost and utilization data.
  • Revise the home health quality reporting program requirements
    • Establish a minimum submission threshold for the number of OASIS assessments that each agency must submit. The initial compliance threshold would be 70% and will increase by 10% increments over the next two years to reach a maximum threshold of 90%.
  • Simplify the therapy reassessment timeframes by having the reassessments occur every 14 calendar days rather than before the 14th and 20th visits and once every 30 calendar days. 
  • Revise the Home Health Conditions of Participation (CoPs) for speech language pathologist personnel by replacing current stringent requirements with a more flexible option that defers to state-licensure requirements.
  • Limit the reviewability of the civil monetary penalty provisions. 
Read the propsed rule.



Topics: HHPPS


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