All Medicare-certified home health agencies (HHAs) that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee will compete on value in the HHVBP model, where payment is tied to quality performance. CMS will implemented the HHVBP model among all HHAs in nine states representing each geographic area in the nation in 2016.

HHAs in these nine states will have their payments adjusted by a maximum payment adjustment of:

  • 3 percent (upward or downward) in 2018,
  • a maximum payment adjustment of 5 percent (upward or downward) in 2019,
  • a maximum payment adjustment of 6-percent (upward or downward) in 2020,
  • a maximum payment adjustment of 7 percent (upward or downward) in 2021,
  • a maximum payment adjustment of 8 percent (upward or downward) in 2022.

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Compared to the proposed rule, the maximum payment reduction in the first year of the value-based purchasing program was reduced from 5 percent to 3 percent.

“Beginning January 1, 2016, CMS will implement the HHVBP model among all HHAs in nine states representing each geographic area in the nation.”

Among the over 1900 HHAs in the selected states that would be expected to be included in the HHVBP Model, we estimate that the maximum percent payment adjustment resulting from this rule will only be greater than minus 3 percent for 10 percent of the HHAs included in the model (using the 8 percent maximum payment adjustment threshold to be applied in CY2022), the rule’s Regulatory Impact Analysis states.

Finally, Section V of this rule includes changes to the home health quality reporting program, including one new quality measure, the establishment of a minimum threshold for submission of Outcome and Assessment Information Set (OASIS) assessments for purposes of quality reporting compliance, and submission dates for Home Healthcare Consumer Assessment of Healthcare Providers and Systems Survey (HHCAHPS) Survey through CY 2018.

Title of the final rule effective January 1: Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Until the rule is published, access the 297-page document at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-27931.pdf


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