The Centers for Medicare & Medicaid Services (CMS) has recently issued its proposed rule for the home health prospective payment system for calendar year 2025. The update is expected to result in a reduction of net home health payments by an estimated $280 million, or -1.7%, compared to the current year.
The proposed rule includes several changes to the home health payment system, including a 3.0% market basket update, reduced by a 0.5% productivity adjustment, and a decrease in the base payment rate by 4.1% due to the implementation of the Patient-driven Groupings Model. Additionally, CMS plans to adjust the fixed-dollar loss amount for high-cost outliers, which is estimated to further reduce payments by 0.6%, or $100 million.
The American Hospital Association (AHA) has expressed serious concerns about these adjustments, especially in light of previous downward payment adjustments in recent years. The AHA believes that these changes will have a negative impact on patient care and quality outcomes in long-term care facilities.
CMS is also proposing changes to the HHA Conditions of Participation, including adding a new standard that would require HHAs to develop, consistently apply, and maintain a policy for accepting patients for service. While no quality measures are being added or removed from the HH Quality Reporting Program, CMS is proposing to adopt and modify certain patient assessment items related to health-related social needs.
Furthermore, CMS plans to revise infection prevention and control requirements for long-term care facilities. This includes extending reporting to the Centers for Disease Control and Prevention of a subset of current COVID-19 data elements and requiring reporting for data related to influenza and RSV to begin on January 1, 2025.
Comments on the proposed rule will be accepted by CMS through August 26. AHA members can expect to receive a Special Bulletin with additional details on the rule in the near future.
In summary, CMS’s proposed rule for calendar year 2025 aims to reduce net home health payments by an estimated $280 million while implementing several changes such as reducing productivity adjustment and Patient-driven Groupings Model implementation among others.