2023 FINAL RULES Home Health


An Analysis and Commentary on Federal Health Care Issues by Larry Goldberg

Final Calendar Year 2023 Home Health Prospective Payment System Update Released

The Centers for Medicare and Medicaid Services (CMS) have issued a final calendar year (CY) 2023 update to the home health prospective payment system (HH PPS). The 232-page rule is currently on display at the Federal Register. A copy is available at: https://public-inspection.federalregister.gov/2022-23722.pdf. Publication is scheduled for November 4. 

The rule: (1) updates the payment rates for HHAs for CY 2023; (2) recalibrates the Patient Driven Groupings Model (PDGM) case-mix weights for 30-day periods of care; (3) finalizes a methodology to determine the impact of differences between assumed behavior changes and actual behavior changes on estimated aggregate Medicare home health expenditures; (4) finalizes a permanent payment adjustment to the CY 2023 30-day period payment rate; updates the low utilization payment adjustment LUPA thresholds, functional impairment levels, and comorbidity subgroups; and (5) updates the CY 2023 fixed-dollar loss ratio (FDL) for outlier payments (so that outlier payments as a percentage of estimated total payments are not to exceed 2.5 percent.) 

The final rule also discusses the comments received on the collection of data on the use of telecommunications technology from home health claims. 

The rule finalizes the end of the suspension of the collection of Outcome and Assessment Information Set (OASIS) data from non-Medicare/non-Medicaid patients pursuant to section 704 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and requires HHAs to report all-payer OASIS data for purposes of the HH QRP. In response to concerns raised by commenters on the burden associated with the proposed new data collection, CMS is finalizing that the new OASIS data reporting for the HH QRP will begin with the CY 2027 program year, with two quarters of data required for that program year. CMS is finalizing a phase-in period for January 1, 2025 through June 30, 2025 in which failure to submit the data will not result in a penalty. 
The rule updates the home infusion therapy services payment rates for CY 2023 under section 1834(u) of the Act. 


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