CY21 Home Health Prospective Payment System Proposed Rule Released

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

On June 25, 2020, CMS issued the annual home health payment proposed rule for calendar year (CY) 2021.  The CY21 Home Health PPS Proposed Rule is scheduled to be published in the Federal Register tomorrow, June 30, 2020. 

Two (2) important reads:

The rule posting “proposes routine updates to the home health payment rates for calendar year (CY) 2021, in accordance with existing statutory and regulatory requirements. This proposed rule also includes a proposal to make permanent the regulatory changes related to telecommunications technologies in providing care under the Medicare home health benefit beyond the expiration of the public health emergency (PHE) for the Coronavirus Disease 2019 (COVID-19) pandemic… This rule includes a proposal to adopt the revised Office of Management and Budget (OMB) statistical area delineations as described in OMB Bulletin 18-04 and proposes to apply a 5 percent cap on wage index decreases in CY 2021. Finally, this rule proposes Medicare enrollment policies for qualified home infusion therapy suppliers and updates the home infusion therapy services payment rates for CY 2021.”

Some key points noted in the Fact Sheet include:

  • Permanently finalize, beginning January 1, 2021, the amendment to the home health regulations outlined in the March 30, 2020 Policy and Regulatory Revisions in Response to the COVID–19 Public Health Emergency Interim Final Rule (85 FR 19230). This would mean that home health agencies (HHAs) can continue to utilize telecommunications technologies in providing care to beneficiaries under the Medicare home health benefit beyond the COVID-19 PHE, as long as the telecommunications technology is related to the skilled services being furnished, is outlined on the plan of care, and is tied to a specific goal indicating how such use would facilitate treatment outcomes.
  • Allow HHAs to continue to report the costs of telecommunications technology as allowable administrative costs on the home health agency cost report beyond the PHE for the COVID-19 pandemic.
  • CMS estimates that Medicare payments to HHAs in CY 2021 would increase in the aggregate by 2.6%, or $540 million, based on the proposed policies. This increase reflects the effects of the proposed 2.7% home health payment update percentage ($560 million increase) and a 0.1% decrease in payments due to reductions made in the rural add-on percentages mandated by the Bipartisan Budget Act of 2018 for CY 2021 ($20 million decrease).
  • Update the home health wage index including the adoption of revised Office of Management and Budget (OMB) statistical area delineations and limiting any decreases in a geographic area’s wage index value to no more than 5% in CY 2021.
  • Implement Medicare enrollment policies for qualified home infusion therapy suppliers and proposes updates to the CY 2021 home infusion therapy services payment rates using the CY 2021 Physician Fee Schedule amounts.

The unpublished version is 138 pages in length.