CMS finalizes 2012 Medicare home health payment changes

Flexibility added to certify requirement

Payments to home health agencies (HHAs) are estimated to decrease by approximately 2.31% or $430 million in calendar year (CY) 2012, the net effect of a 1.4% payment update, the wage index update, and the case-mix coding adjustment, according to the Centers for Medicare and Medicaid Services' (CMS).

CMS also reduced Home Health Prospective Payment System (HH PPS) rates in CY 2012 to account for additional growth in aggregate case-mix that is unrelated to changes in patients' health status. CMS has finalized a 3.79% reduction to the home health PPS rates for CY 2012 and an additional 1.32% reduction for CY 2013.

Structural changes to the HH PPS were made by removing two hypertension codes from the case-mix system, lowering payments for high therapy episodes, and recalibrating the HH PPS case-mix weights to ensure that these changes result in the same amount of total aggregate payments. These changes are intended to increase payment accuracy and reduce the growth in aggregate case-mix that is unrelated to changes in patients' health status.

Under current Medicare policy, a certifying physician or an allowed non-physician practitioner must see a patient prior to certifying a patient as eligible for the home health benefit. The rule now allows physicians who cared for the patient in an acute or post-acute facility to inform the certifying physician of their encounters with the patient in order to satisfy the requirement.