CMS released the CY 2024 home health final payment rule last November 1. CMS estimates that Medicare payments to HHAs in CY 2024 will increase in the aggregate by 0.8 percent, or $140 million, compared to CY 2023.
The final rule sets a permanent payment adjustment of -2.890 percent for the CY 2024 home health 30-day period payment rate, which is half of the initially proposed -5.779 percent. Due to CMS only implementing about half of the projected full permanent adjustment, Medicare payments to HHAs in CY 2024 will rise by 0.8 percent instead of the proposed 2.2 percent decrease.
Key updates:
Disposable Negative Pressure Wound Therapy
CMS finalized changes for negative pressure wound therapy (NPWT) using a disposable device for patients under a home health plan of care. Beginning January 1, 2024, there is a separate payment for the device only. Payment for the services to apply the device is to be included in the 30-day payment under the home health prospective payment system. There are also changes that allow HHAs to now report the disposable device on the type of home health claim most familiar to HHAs.
Home Health (HH) Quality Reporting Program (QRP)
CMS is finalizing the addition and removal of certain measures to the HH QRP
New measures introduced:
- COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date (Patient/Resident COVID-19 Vaccine) measure
- Functional Discharge Score (DC Function) measure
Measures to be removed:
- M0110 – Episode Timing
- M2220- Therapy Needs items.
- With the addition of the Discharge Function measure, CMS finalized to remove the following measures from the HH QRP beginning with the CY 2025 HH QRP:
- Application of Percent of Long-Term Care Hospital (LTCH) Patients with an Admission and
- Discharge Functional Assessment and a Care Plan That Addresses Function (Application of Functional Assessment/Care Plan)
Additional measures for public reporting
- Discharge Function;
- Transfer of Health (TOH) Information to the Provider—Post-Acute Care (PAC) Measure (TOH-Provider);
- Transfer of Health (TOH) Information to the Patient—Post-Acute Care (PAC) Measure (TOH-Patient); and
COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date.
Expanded Home Health Value-Based Purchasing (HHVBP) Model
Changes in the Applicable Measure Set used in the expanded Home Health Value-Based Purchasing (HHVBP) Model effective January 1, 2025.
- The two Total Normalized Composite Measures (for Self-Care and Mobility) will be replaced with the Discharge Function Score measure.
- The OASIS-based Discharge to Community (DTC) measure will be replaced with the claims-based Discharge to Community-Post Acute Care (PAC) Measure for Home Health Agencies.
Replace the claims-based Acute Care Hospitalization During the First 60 Days of Home Health Use and the Emergency Department Use without Hospitalization During the First 60 Days of Home Health measures will be replaced with the claims-based Potentially Preventable Hospitalization measure.
Other changes:
- Recalibration of the PDGM case-mix weights.
- Updates to the low utilization payment adjustment (LUPA) thresholds, functional impairment levels, and comorbidity adjustment subgroups for CY 2024.
- Establishment of regulations to implement payment for items and services under two new benefits: lymphedema compression treatment items and home intravenous immune globulin (IVIG).
