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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?

These past two years have been exceedingly eye opening for the medical world and the home health sector in particular as we are clearly still involved in a public health emergency. The COVID-19 pandemic escalated the importance of home health care as a needed and valued alternative to institutional and facility based care settings. In addition, as Valued Based Purchasing (VBP) will come onto the scene in early 2022, many agencies have had to shift the way they admit and care for higher acuity patients in a more efficient, cost effective, and responsive manner. 

Recent functional impairment data and staffing intel presented at the National Association of Home Care and Hospice (NAHC) Financial Managers Conference (FMC) surrounding visit utilization highlights the enhanced need to implement strategic scheduling. PDGM set out the initiative to reimburse agencies based on patient acuity and left it to providers to determine the appropriate level of care.

Our HealthPRO Heritage leadership team recently attended the National Association of Home Care and Hospice (NAHC) Financial Managers Conference (FMC) in Chicago. The FMC is where industry leaders of home care and hospice connect on industry trends and opportunities. All the buzz this year was centered around:

The Centers for Medicare and Medicaid Services (CMS) released the Home Health 2022 proposed rule on Monday, June 28, 2021. We're breaking down the details, enjoying the fireworks (including a slight increase in reimbursement!), and talking future of home health.

Most Notable Elements of the Proposed Rule

CMS is proposing a $310M increase in Home Health payments in 2022, which equates to an increase in payment by 1.8%! This proposed increase adjusts the 30-day payment base rate from $1901.12 to $2012.43. However, despite quite a bit of controversy and advocacy efforts to have the behavioral adjustments that were implemented in 2020 with the conversion to PDGM modified, they remain intact at a 4.36%.

As more and more home health agencies shift to outsourcing their therapy services, it is important to understand the qualities that a great therapy partner should have. Certainly, therapy is an integral component of delivering quality care in the home and it’s critical to chose the right partner that can provide therapy expertise along with resources for success.

As home health agencies work to implement strategies to provide quality patient care while also reaching operational success, many agencies are outsourcing all or a portion of therapy services to a trusted partner.

As most in the industry are aware, current Medicare policy does not allow occupational therapy alone to establish eligibility for home health services, unlike physical therapy and speech-language pathology. Occupational therapy plays an essential role in home health, but is currently only able to stand alone or continue services after an individual has been discharged from all other home health service.

As most home health providers are aware, beginning on 1/1/21 financial penalties will start to incur for any RAP (Request for Anticipated Payment) submission that occurs after 5 days from when a patient is admitted to home health services. Here is a breakdown of what this updated RAP submission will look like and exactly what financial penalties will occur:

Reimbursement, revenue, payment, or better yet, the term “cash flow” seems to be on the mind of every home health agency in the nation today. Not only were agencies hit with the RAP reduction from 60% to a minimum 20% with the start of PDGM in January 2020; but the COVID-19 pandemic, which began in March, seemed to throw gasoline onto an already large cash flow fire by increasing the occurrence of LUPAs (Low Utilization Payment Adjustment).