Welcome to the HealthPRO Heritage Blog

Since the RCS-1 Proposed Rule was released in Spring 2017, through the PDPM Final Rule and up to today, we’ve spent hundreds of hours thinking and pressure testing different ideas. We’ve had ongoing conversations with customers, colleagues, and consultants about PDPM therapy pricing. Our goal was simple: Develop a pricing approach which equally addresses and ensures the success of our patients, customers, and employees under PDPM. 

On Friday, January 14, 2022, the Secretary of Health and Human Services, Xavier Becerra, declared a renewal of the Public Health Emergency declaration, effective January 16, 2022. For an additional 90 days, this allows for access to waiver or modification of requirements under Section 1135 of the Social Security Act. The new expiration date is set for April 16, 2022. CMS has committed to provide notice of the PHE end prior to the expiration date, with a 60-day notice promised. The link to view this declaration: https://aspr.hhs.gov/legal/PHE/Pages/COVID19-14Jan2022.aspx  

The past two years pressure-tested the Senior Living industry in unprecedented ways. Have your partners (or those you may be considering) helped see you through the unique challenges? Are they still the best fit in today's environment to help you weather the storm in 2022 & beyond?

This is an active time from a regulatory perspective. Please see the below updates on Medicare Part B reimbursement reductions, vaccine requirements, and a new COVID variant. Advocacy remains critical – please join the fight against Medicare Part B reimbursement cuts here.

HealthPRO Heritage invites health services providers from across the spectrum of care to Envision Everything!

CMS published the final rule for CY2022 making official the nationwide expansion of the HHVBP Model. The HHVBP Model is one of four Innovation Center models that have met the requirements to be expanded in duration and scope since 2010. Given this expansion, CMS is also ending the HHVBP Model for participants in the original model’s nine states. The first performance year of the expanded HHVBP Model will be CY 2023, with quality performance data from that year used to calculate payment adjustments under the expanded Model in CY 2025. Throughout 2022, CMS will provide technical assistance to HHAs to ensure they understand how performance will be assessed as finalized in this rule. To take an in-depth look at VBP click here: What is Value Based Purchasing?

Seems as though CMS has taken a page out of Dorothy’s book with the mantra, “there’s no place like home.”  And those of us who have been in healthcare for any extended period of time can say, “We aren’t in Kansas anymore!” 

Nowadays, dozens of companies offer to set up therapy services within Senior Living communities. In most of these arrangements, the therapy company reimburses the Senior Living community for the gym space (via a lease agreement) and bills residents’ insurances directly for the therapy services they provide. Residents benefit because they have convenient access to rehab services. Therapy companies benefit by generating revenue via a robust caseload of patients.

But what’s in it for the Senior Living communities?

Value-Based Purchasing (VBP) will go into effect on January 1, 2023. The model incentivizes quality of care improvements while ensuring there is no limitation in coverage for Medicare beneficiaries and includes updated payment rates and reimbursement to Home Health Agencies (HHAs).