CMS Issues Home Health Agencies and Home Infusion Therapy Suppliers Payment and Policy Changes

November 13, 2018

On October 26, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1689-F] on Medicare policy changes for home health services and home infusion therapy services for 2019 and 2020.  

WHA’s Post-Acute Work Group recognized the need for some of these policy changes, which will affect WHA members because of the impact on post-acute care provided to patients in the home setting. The rule also implements payment changes for 2019 and 2020. 

Remote Patient Monitoring  
The Post-Acute Work Group acknowledged that remote health monitoring, when combined with a consistent link to follow-up health care coaching, has been shown to be beneficial for post-acute care patients discharged to the home. In the rule, CMS includes the cost of remote patient monitoring as an allowable cost on the home health agency cost report. This will allow reimbursement when patients share more live-time data with their providers and caregivers, which will hopefully lead to more tailored care and better health outcomes.

Payment for Home Infusion Therapy Services
The 21st Century Cures Act created a new permanent Medicare benefit for home infusion therapy services beginning January 1, 2021. The final rule provides, for calendar years 2019 and 2020, a temporary transitional payment for home infusion therapy services that pays eligible suppliers for associated professional services for the following: administering certain drugs and biologicals infused through a durable medical equipment pump; training and education; and remote monitoring and monitoring services.  

This rule also finalizes elements of the permanent home infusion benefit, including the health and safety standards for home infusion therapy, an accreditation process for qualified home infusion therapy suppliers, and an approval and oversight process for the organizations that accredit qualified home infusion therapy suppliers.  

Payment Updates
CY 2019 payments will increase by a net 2.2%, or $420 million, after all payment policy changes when compared to 2018 payment levels. The rule also implements several additional policy changes, some of which are as follows:

  • As mandated by the Bipartisan Budget Act of 2018 and following the trends in payment model reform being pursued by CMS, Medicare will, in 2020, stop using the number of therapy visits provided to determine home health payment. 
  • Current therapy thresholds encourage volume over value. CMS will implement a new payment model, the Patient-Driven Groupings Model (PDGM) for home health periods of care beginning on or after January 1, 2020. The PDGM is designed to reflect CMS’s focus on relying more heavily on clinical characteristics and other patient information to allow payments to more closely reflect patients’ needs. 
  • The rule changes the unit of payment under the home health prospective payment system from 60-day to 30-day periods of care. This change is being made because most 60-day episodes have more visits on average during the first 30 days. Dividing a single 60-day episode into two periods allows payments to be more accurately apportioned.
Questions on this rule may be referred to Laura Rose, WHA Vice President, Policy Development. 

This story originally appeared in the November 13, 2018 edition of WHA Newsletter