FutureFocus February 21, 2018: Reforms Ahead: Hospital Discharges, Telehealth, Hospice, and Payment Systems

Lisa Remington

In this week’s FutureFocus, we discuss four reforms coming to your organization. Key topics will impact home health payment reform, hospice, a new hospital discharge penalty, and the expansion of telehealth. We provide insights to each reform.

Lisa Remington, President, Remington Health Strategy Group

The Bipartisan Budget Act (PL115-123) signed into law by President Trump February 9 includes a requirement for the HHS Secretary to reform the current home health payment system, implementing a 30-day episode for payment, beginning January 1, 2020.

This change from the current 60-day is required to be budget neutral—an important distinction from the controversial, home health groupings model (HHGM) proposal of last year for 2019. CMS estimated then that payments could be reduced by as much as $950 million in 2019 alone. That projected impact galvanized opposition from the home health industry, and with their allies in Congress, forced CMS to withdraw this model when issuing the final, November 7 PPS rule.

"The Budget law also requires the FY20 market basket update for home health agencies to be 1.5 percent. (The market basket increase was 1 percent for 2018 in the final PPS rule.)"

The new law keeps the government operating through March 23—giving Congress time to craft detailed appropriations bills funding government agencies through the fiscal year. Among other Medicare provisions in the massive law affecting post-acute:

  • For information to satisfy documentation of Medicare eligibility for home health services, the law specifies, on or after January 1, 2019, in addition to the certifying physician “the [HHS] Secretary may use documentation in the medical record of the home health agency as supporting material, as appropriate to the case involved.”
  • A five-year extension with reforms of the home health rural add-on until October 1, 2022. The reforms include a new methodology to target the add-on payment to those areas with a population density of six or fewer individuals per square mile.
  • Permanent repeal of the Medicare payment cap for therapy services beginning on January 1, 2018, and a lower threshold for the targeted manual medical review process from $3,700 to $3,000.