Medicare Decreases Payment To Home Health Agencies by 4.75%

The Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) sent Medicare news for immediate release today from the Office of Media Affairs in Washington, DC. CMS is proposing payment changes to Medicare home health services for 2011.

CMS is attempting to make Medicare home health payments for 2011 more efficient by implementing provisions of the Affordable Care Act (ACA). By doing this, they are hoping to improve the overall integrity of the program.

The "Federal Register" publication announced the proposed rule today, that says that a 4.75 percent decrease in Medicare payments to home health agencies for calendar year 2011 will be put into effect. This is an estimated net decrease of 900 million dollar compared to payments that home health agencies received in the calendar year of 2010.

Jonathan Blum, director of the Center for Medicare and deputy administrator for CMS, stated, “The new home health provisions will help ensure more accurate payments under Medicare and reflect prudent financial stewardship of the Medicare Trust Fund.”

The following are some of the details that the new rule offers. The ACA will mandate that, "prior to certifying a patient’s eligibility for the Medicare home health benefit, the physician must document that the physician or a non-physician practitioner has had a face-to-face encounter with the patient"

Blum stated, “Patient care and access are ultimately what CMS is looking to protect, while working aggressively to prevent fraud. The proposed rule establishes timeframes for these encounters and documentation requirements associated with the provision."

Also, home health agencies that change ownership within three years of initial enrollment in the program, were obligated to obtain a new State survey or accreditation. The new CMS ruling now proposes exceptions to the three year provision for certain types of ownership transactions. CMS also mandates that policies regarding the coverage of therapy services in the home health setting are clear and easy to understand. Finally, CMS mandates quality reporting of patient charts as it relates to the Home Health Consumer Assessment of Healthcare Providers and Systems Survey.

Finally, the rule proposes an approach to implement an ACA hospice provision, which requires a hospice physician or nurse practitioner to see a patient prior to recertifying the patient’s eligibility for hospice services.

For full information on this new proposal, please visit the CMS website.

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