Home health care is a formal, regulated program of care delivered by a variety of health care professionals in the patient’s home for the treatment of a medical condition, illness or disability. Home health is provided through certified home health agencies (HHAs).
As components of the post-acute continuum of care, HHAs provide essential health care services. This specialized support allows patients to remain at home when they would otherwise have to be admitted to a costly institutional setting, such as a skilled-nursing facility or hospital.
CHA provides state and federal representation and advocacy in the legislative and regulatory arenas to improve access to quality, cost-effective home health care services.
The Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network has issued an article titled “Documentation Requirements for Home Health Prospective Payment System (HH PPS) Face-to-Face Encounter.” The article is designed to provide education on the required narrative for documenting the home health face-to-face encounter, and includes information and examples to help health care professionals avoid insufficient documentation errors and HH PPS improper payments. A copy of the article is attached.
To clarify coverage policies following a recent settlement agreement, the Centers for Medicare & Medicaid Services (CMS) has revised portions of its Medicare Benefit Policy Manual on services provided by skilled-nursing facilities, inpatient rehabilitation facilities, home health agencies and outpatient therapy. Based on the settlement agreement, Jimmo v. Sebelius, CMS Transmittal 176 specifies that standards requiring potential for improvement may not be applied as a rule of thumb to determine Medicare coverage for services that require skilled-nursing care or skilled therapy services. It also provides guidance on appropriate documentation. CMS notes that the transmittal, attached, does not represent an expansion of benefits or a change in Medicare’s longstanding policy on the need for skilled-nursing care and skilled-therapy services.
Home health (HH) agencies paid under Medicare’s prospective payment system (PPS) will see a 1.05 percent decrease in payments in calendar year (CY) 2014 as compared to CY 2013 under a final rule released by the Centers for Medicare & Medicaid Service (CMS). The decrease reflects the combined effects of an increase in the home health market basket update percentage of 2.3 percent, offset by a rebasing adjustment of negative 2.7 percent as required by the Affordable Care Act (ACA), and a .62 percent decrease due to a refinement of the HH PPS Grouper. The ACA requires CMS to begin phasing in rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates and the non-routine supply conversion factor to reflect changes since the inception of the HH PPS. For hospital-based facilities, CMS estimates the reduction will be smaller, negative .58 percent, for CY 2014.