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

Final Home Health CY 2024 Home Health Prospective Payment System Update Released

The Centers for Medicare and Medicaid Services (CMS) have issued its final calendar year (CY) 2024 update to the home health prospective payment system (HH PPS). The 531-page rule is currently on display at the Federal Register. A copy is at: https://public-inspection.federalregister.gov/2023-24455.pdf. Publication is scheduled for November 13. 

The rule will update Medicare payment policies and rates, adopt a permanent prospective adjustment to the CY 2024 home health payment rate to account for the impact of the implementation of the Patient-Driven Groupings Model (PDGM). This adjustment accounts for differences between assumed behavior changes and actual behavior changes on estimated aggregate expenditures due to the implementation of the PDGM and 30-day unit of payment as required by the Bipartisan Budget Act of 2018

In addition, CMS is rebasing and revising the home health market basket; revising the labor related share; recalibrating the PDGM case-mix weights; updating the low utilization payment adjustment (LUPA) thresholds, functional impairment levels, and comorbidity adjustment sub-groups. 
CMS is codifying, statutory requirements for disposable negative pressure wound therapy (dNPWT), and establishing regulations to implement payment for items and services under two new benefits; lymphedema and compression treatment items and home intravenous immune globulin (IVIG) as required by the Consolidated Appropriations Act of 2023, (CAA)

Additionally, the rule makes changes to the Home Health Quality Reporting Program (HH QRP) requirements and expands the Home Health Value-Based Purchasing (HHVBP) Model resulting from  recent legislation; to add an informal dispute resolution (IDR) and special focus program (SFP)  for hospice programs; to codify DMEPOS refill policy; and to revise Medicare provider and  supplier enrollment requirements.  

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