Centers for Medicare & Medicaid Services Home Health Study Report, 2011
Centers for Medicare & Medicaid Services issued a study on home health care in 2011. Click here to access the entire report.
The Medicare home health benefit provides care to homebound individuals who are ill or injured and require intermittent (part-time) skilled nursing services or skilled therapy (CMS, Medicare and Home Health Care, 2010), covering about 3.3 million beneficiaries and resulting in $16.5 billion in total Medicare payments in 2008 (CMS, Data Compendium, 2009). The intent of Congress in crafting the benefit was to provide skilled services to treat a patient’s illness or injury for a finite and predictable period of time. While delivering home care to individuals recovering from acute-setting injuries or illness may result in overall savings (McKnight, 2006), caring for the chronically sick – patients whose illnesses may last a long time and will not likely resolve – is expensive and has elicited debate regarding the role the government should play in financing such care (Buhler-Wilkerson, 2007). Medicare payment policy for home health services has changed several times in the last decade, underscoring concerns regarding both Medicare’s financial responsibility and the ability of home health agencies (HHAs) to respond to payment policy changes (FitzGerald, Boscardin, & Ettner, 2009).
One such significant change occurred with the creation and implementation of the Home Health Prospective Payment System (HH PPS) on Oct. 1, 2000, which was designed to bundle Medicare payment on the basis of a national standardized 60-day episode of care for all covered home health services, including medical supplies, paid on a reasonable cost basis, adjusted for patient severity by a case mix that is based on a patient’s clinical, functional and service utilization as well as geographic variation in costs and unusually low utilization or high-cost outliers. Covered home health services include: skilled nursing services, home health aide services, physical therapy services, speech-language pathology services, occupational therapy services, medical social work, and routine (built into the visit rates) and non-routine medical supplies. Beneficiaries may receive an unlimited number of consecutive home health episodes as long as they meet the eligibility standards for the benefit.
Section 3131(d) of the Patient Protection and Affordable Care Act (ACA) requires the Secretary to conduct a study on HHA costs. To that end, the Centers for Medicare & Medicaid Services (CMS) contracted L&M Policy Research, LLC (L&M), to develop an analytic plan and provide background to aid the development of a study and report on potential revisions to the HH PPS. The goal of the study and report is to ensure access to care and adequate payment for vulnerable populations. Specifically, the legislation requires CMS to conduct a study on HHA costs involved in providing ongoing care to Medicare beneficiaries with low income, living in medically underserved areas, and requiring treatment for varying levels of severe illness. Further, the legislation requires CMS to analyze potential revisions to the HH PPS that account for costs related to severity of illness and improvement of access to care; subsequently, CMS will submit a report to the U.S. Congress on the study with recommendations for legislative and administrative action as the agency deems appropriate. For this scope of work, CMS has requested L&M analyze methods to potentially revise the HH PPS that address such concerns. This literature review will contribute to the evidence base for the remainder of the project.
For the latest in CMS Home Health Care Updates, go to:
CY 2012 Rulemaking
CMS-1353-P: {2012 HHA wage index tables } (Display Date: July 5, 2011): A proposed rule was displayed at the Federal register, proposing to update the Medicare Home Health Prospective Payment (HH PPS) rates for CY 2012 by a negative 3.35 percent. This includes an estimated net decrease of $640 million compared to HHA payments in CY 2011. This update includes the combined effects of the 1.5 percent market basket and wage index updates (a $310 million increase), as well as reductions to the HH PPS rates to account for increases in aggregate case-mix that are not related to changes in the health status of patients (a $950 million decrease). This rule also proposes structural changes to the HH PPS by removing two hypertension codes from the case-mix system, lowering payments for high therapy episodes and recalibrating the HH PPS case-mix weights to ensure that these changes result in the same aggregate payments. Finally this rule proposes added flexibility to allow physicians who attend to a home health patient in an acute or post-acute setting to inform the certifying physician of their encounters with the patient in order to satisfy the face-to-face encounter requirement.
Open Door Forum
CMS Open Door Forum: Home Health Study and Report [PDF, 168KB]
Home Health Study Report Literature Review [PDF, 430KB]
Home Health Face-to-Face
Home Health Face-to-Face FAQs 10484, 10633, 10634, and 10635, - (updated 5/6/2011)
Chapter 4 Physician Certification and Recertification of Services Manual Changes (4/22/11)
Update on Physician Signature Requirement and Face-to-Face Encounter Requirements (3/31/11)
Home Health Face-to-Face Q&As (updated 3/17/11) -- Physician Q&As
Chapter 7 Home Health Manual Updates with Face-to-Face Revisions – February 16, 2011
Additional Time to Establish Protocols for Newly Required Face-to-Face Encounters for Home Health and Hospice Recertification – December 23, 2010
Home Health face-to-face Guidance PowerPoint (2/16/11)
Special Edition MLN Matters article detailing home health face-to-face provision and requirements (12/22/10)
Listserv home health face-to-face announcement (12/20/10)
Therapy and Skilled Nursing
Therapy Q&As (6/30/11)
Chapter 7 Home Health Manual Update with Therapy Revisions (5/6/11)
Therapy Requirements Fact Sheet (3/23/11)
CR 7182 submitted implementing new therapy and nursing reporting requirements, as well as 2 new G codes (12/22/10)
MLN Matters article issued detailing new and revised therapy and nursing requirements (12/22/10)
2011 Alpha-numeric HCPCS complete list of the new and revised G Codes and descriptions (12/22/10)
Medicare Learning Network (MLN) Spotlights
Go to the Spotlight page for the latest MLN products and announcements! Check it often!
Important Links
Billing / Payment
Home Health PPS
Home Health Coding and Billing
Home Health PPS - PC Pricer
CY 2011 Home Health PPS Wage Index File [ZIP, 37KB]
Home Health Case Mix Grouper Software Package
Policies/Regulations
Home Health Regulations and Notices
Quarterly Provider Update
Initiatives
Home Health Quality Initiative - Overview
Home Health Compare
Beneficiary Notices Initiative (BNI) - Overview
FFS HHABN
FFS ED Notices
Outcome and Assessment Information Set (OASIS)
OASIS - Overview
OASIS User's Manual
OASIS - (Attachment D: Selection & Assignment of OASIS Diagnosis) Guidance
Home Health Agency OASIS Statement of Patient Privacy Rights
Research and Analyses
Analysis of Home Health Case-Mix Change 2000-2008 [ZIP, 45KB]
"Refinement of Medicare's Home Health Prospective Payment System: Final Report" [PDF, 2.6MB] and the Appendix containing associated tables [PDF, 966KB]
"Analysis of 2006-2007 Home Health Case-mix Change [PDF, 1.09MB]"
CMS Manuals & Transmittals
CMS Manuals
CMS Internet-only Manuals.
Home Health Specific Program Transmittals
Program Transmittals
Program Memoranda
Participation, Enrollment & Certification
Conditions for Coverage (CfCs) & Conditions of Participations (CoPs): Home Health Services
Conditions of Participation: Home Health Agencies (42 CFR 484.1)
Provider Enrollment
Educational Resources
Medicare Learning Network (MLN)
MLN Educational Web Guides
MLN Matters Articles (Search)
MLN Products
Demonstration
Home Health Demonstrations
How to Stay Informed
Join the Home Health PPS mailing list (or listserv). Scroll to the right side of the page to Subscribe.
Open Door Forum - Home Health, Hospice & Durable Medical Equipment
Press Releases
Contacts
Contact Your Regional Home Health Intermediary/ Medicare Administrative Contractor via Toll-Free Numbers and Websites -- A listing of the toll-free numbers that CMS has installed at Medicare FFS contractor sites.
Quality Improvement Organizations (QIO)
CMS Regional Offices
Contacting the Coordination of Benefits Contractors (COBC
For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors and other family members, contact Brian Gauthier at A Family Member HomeCare (954) 986-5090 or http://www.afamilymemberhomecare.com/. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach Home health care agencies home health care agency home health care services in home health care senior home health care home health care providers health care agency home health care jobs at home health care home health care agencies in florida home health care florida medicare home health care health care agencies home health care elderly home health agency home health care service home care agencies home health care companies home health care agency florida private home health care home health agencies elderly home health care home care agency what is home health care home health care agencies in broward county home health services home health care cost accessible home health care florida home health care home health aide agencies in home health care services home health care business home health aide home health care nursing home health care provider home health care employment in home health care jobs home health aide jobs home health aides home health care medicare in home health care agencies home health care seniors
The Medicare home health benefit provides care to homebound individuals who are ill or injured and require intermittent (part-time) skilled nursing services or skilled therapy (CMS, Medicare and Home Health Care, 2010), covering about 3.3 million beneficiaries and resulting in $16.5 billion in total Medicare payments in 2008 (CMS, Data Compendium, 2009). The intent of Congress in crafting the benefit was to provide skilled services to treat a patient’s illness or injury for a finite and predictable period of time. While delivering home care to individuals recovering from acute-setting injuries or illness may result in overall savings (McKnight, 2006), caring for the chronically sick – patients whose illnesses may last a long time and will not likely resolve – is expensive and has elicited debate regarding the role the government should play in financing such care (Buhler-Wilkerson, 2007). Medicare payment policy for home health services has changed several times in the last decade, underscoring concerns regarding both Medicare’s financial responsibility and the ability of home health agencies (HHAs) to respond to payment policy changes (FitzGerald, Boscardin, & Ettner, 2009).
One such significant change occurred with the creation and implementation of the Home Health Prospective Payment System (HH PPS) on Oct. 1, 2000, which was designed to bundle Medicare payment on the basis of a national standardized 60-day episode of care for all covered home health services, including medical supplies, paid on a reasonable cost basis, adjusted for patient severity by a case mix that is based on a patient’s clinical, functional and service utilization as well as geographic variation in costs and unusually low utilization or high-cost outliers. Covered home health services include: skilled nursing services, home health aide services, physical therapy services, speech-language pathology services, occupational therapy services, medical social work, and routine (built into the visit rates) and non-routine medical supplies. Beneficiaries may receive an unlimited number of consecutive home health episodes as long as they meet the eligibility standards for the benefit.
Section 3131(d) of the Patient Protection and Affordable Care Act (ACA) requires the Secretary to conduct a study on HHA costs. To that end, the Centers for Medicare & Medicaid Services (CMS) contracted L&M Policy Research, LLC (L&M), to develop an analytic plan and provide background to aid the development of a study and report on potential revisions to the HH PPS. The goal of the study and report is to ensure access to care and adequate payment for vulnerable populations. Specifically, the legislation requires CMS to conduct a study on HHA costs involved in providing ongoing care to Medicare beneficiaries with low income, living in medically underserved areas, and requiring treatment for varying levels of severe illness. Further, the legislation requires CMS to analyze potential revisions to the HH PPS that account for costs related to severity of illness and improvement of access to care; subsequently, CMS will submit a report to the U.S. Congress on the study with recommendations for legislative and administrative action as the agency deems appropriate. For this scope of work, CMS has requested L&M analyze methods to potentially revise the HH PPS that address such concerns. This literature review will contribute to the evidence base for the remainder of the project.
For the latest in CMS Home Health Care Updates, go to:
CY 2012 Rulemaking
CMS-1353-P: {2012 HHA wage index tables } (Display Date: July 5, 2011): A proposed rule was displayed at the Federal register, proposing to update the Medicare Home Health Prospective Payment (HH PPS) rates for CY 2012 by a negative 3.35 percent. This includes an estimated net decrease of $640 million compared to HHA payments in CY 2011. This update includes the combined effects of the 1.5 percent market basket and wage index updates (a $310 million increase), as well as reductions to the HH PPS rates to account for increases in aggregate case-mix that are not related to changes in the health status of patients (a $950 million decrease). This rule also proposes structural changes to the HH PPS by removing two hypertension codes from the case-mix system, lowering payments for high therapy episodes and recalibrating the HH PPS case-mix weights to ensure that these changes result in the same aggregate payments. Finally this rule proposes added flexibility to allow physicians who attend to a home health patient in an acute or post-acute setting to inform the certifying physician of their encounters with the patient in order to satisfy the face-to-face encounter requirement.
Open Door Forum
CMS Open Door Forum: Home Health Study and Report [PDF, 168KB]
Home Health Study Report Literature Review [PDF, 430KB]
Home Health Face-to-Face
Home Health Face-to-Face FAQs 10484, 10633, 10634, and 10635, - (updated 5/6/2011)
Chapter 4 Physician Certification and Recertification of Services Manual Changes (4/22/11)
Update on Physician Signature Requirement and Face-to-Face Encounter Requirements (3/31/11)
Home Health Face-to-Face Q&As (updated 3/17/11) -- Physician Q&As
Chapter 7 Home Health Manual Updates with Face-to-Face Revisions – February 16, 2011
Additional Time to Establish Protocols for Newly Required Face-to-Face Encounters for Home Health and Hospice Recertification – December 23, 2010
Home Health face-to-face Guidance PowerPoint (2/16/11)
Special Edition MLN Matters article detailing home health face-to-face provision and requirements (12/22/10)
Listserv home health face-to-face announcement (12/20/10)
Therapy and Skilled Nursing
Therapy Q&As (6/30/11)
Chapter 7 Home Health Manual Update with Therapy Revisions (5/6/11)
Therapy Requirements Fact Sheet (3/23/11)
CR 7182 submitted implementing new therapy and nursing reporting requirements, as well as 2 new G codes (12/22/10)
MLN Matters article issued detailing new and revised therapy and nursing requirements (12/22/10)
2011 Alpha-numeric HCPCS complete list of the new and revised G Codes and descriptions (12/22/10)
Medicare Learning Network (MLN) Spotlights
Go to the Spotlight page for the latest MLN products and announcements! Check it often!
Important Links
Billing / Payment
Home Health PPS
Home Health Coding and Billing
Home Health PPS - PC Pricer
CY 2011 Home Health PPS Wage Index File [ZIP, 37KB]
Home Health Case Mix Grouper Software Package
Policies/Regulations
Home Health Regulations and Notices
Quarterly Provider Update
Initiatives
Home Health Quality Initiative - Overview
Home Health Compare
Beneficiary Notices Initiative (BNI) - Overview
FFS HHABN
FFS ED Notices
Outcome and Assessment Information Set (OASIS)
OASIS - Overview
OASIS User's Manual
OASIS - (Attachment D: Selection & Assignment of OASIS Diagnosis) Guidance
Home Health Agency OASIS Statement of Patient Privacy Rights
Research and Analyses
Analysis of Home Health Case-Mix Change 2000-2008 [ZIP, 45KB]
"Refinement of Medicare's Home Health Prospective Payment System: Final Report" [PDF, 2.6MB] and the Appendix containing associated tables [PDF, 966KB]
"Analysis of 2006-2007 Home Health Case-mix Change [PDF, 1.09MB]"
CMS Manuals & Transmittals
CMS Manuals
CMS Internet-only Manuals.
Home Health Specific Program Transmittals
Program Transmittals
Program Memoranda
Participation, Enrollment & Certification
Conditions for Coverage (CfCs) & Conditions of Participations (CoPs): Home Health Services
Conditions of Participation: Home Health Agencies (42 CFR 484.1)
Provider Enrollment
Educational Resources
Medicare Learning Network (MLN)
MLN Educational Web Guides
MLN Matters Articles (Search)
MLN Products
Demonstration
Home Health Demonstrations
How to Stay Informed
Join the Home Health PPS mailing list (or listserv). Scroll to the right side of the page to Subscribe.
Open Door Forum - Home Health, Hospice & Durable Medical Equipment
Press Releases
Contacts
Contact Your Regional Home Health Intermediary/ Medicare Administrative Contractor via Toll-Free Numbers and Websites -- A listing of the toll-free numbers that CMS has installed at Medicare FFS contractor sites.
Quality Improvement Organizations (QIO)
CMS Regional Offices
Contacting the Coordination of Benefits Contractors (COBC
For more information about a Miami-Dade, Broward and Palm Beach County home health care agency for seniors and other family members, contact Brian Gauthier at A Family Member HomeCare (954) 986-5090 or http://www.afamilymemberhomecare.com/. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach Home health care agencies home health care agency home health care services in home health care senior home health care home health care providers health care agency home health care jobs at home health care home health care agencies in florida home health care florida medicare home health care health care agencies home health care elderly home health agency home health care service home care agencies home health care companies home health care agency florida private home health care home health agencies elderly home health care home care agency what is home health care home health care agencies in broward county home health services home health care cost accessible home health care florida home health care home health aide agencies in home health care services home health care business home health aide home health care nursing home health care provider home health care employment in home health care jobs home health aide jobs home health aides home health care medicare in home health care agencies home health care seniors
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