The Bipartisan Budget Act was recently signed into law. This legislation includes language from the U.S. House of Representatives Continuing Resolution, which directs funding for the government through March 23, in addition to raising the debt ceiling and spending parameters for governmental budget caps through October 2019.
Below are the key impacts from the signed law:
Rural add-on: This program which provides an additional 3% reimbursement for home health services provided in rural areas was extended for an additional 3 – 5 years, depending on certain conditions.
- All eligible claims will receive 3% in 2018
- Services provided in frontier areas (defined as 6 or fewer people per square mile) will see an additional 4% in 2019, 3% in 2020, 2% in 2021, and 1% in 2022
- The top 25% of eligible counties by utilization will receive 1.5% in 2019, and 0.5% in 2020
- Every other eligible claim not included in the two preceding groups will receive 3% in 2019, 2% in 2020, and 1% in 2021
Additionally, as a result of advocacy efforts, a study analyzing opportunities for strengthening and improving the add-on will be conducted. This will allow for future debates to keep the add-on in place beyond this phase-out approach.
Payment Reforms: Episode units will now be on 30 day periods rather than the current 60 day model. Additionally, the therapy domain will no longer be used as a payment determinant. Behavior adjustments made by CMS will be more transparent, and a notice and comment period will be required. The reform must also respond to behavior assumptions that are made, but are not realized in practice. All reforms are set to go into effect in 2020, and are required to be budget neutral.
Market Basket Update: In 2020, the inflation factor, the market basket update, will be set at 1.5%
Face-to-face/Physician Documentation Certification: The legislation included a provision similar to HR 2663, which directs CMS to consider the home health agency record in conjunction with the physician record in determining claim status. The language included in the spending package addressing the requirement does not necessarily direct CMS to consider the home health agency record as NAHC would have preferred. It will be up to CMS’s interpretation for how this provision is implemented.
HR 2663 also called for a settlement process for past denied claims resulting from the face-to-face requirement currently residing in an appeals backlog. That provision was not included in the spending package.
CHRONIC Care: This provision is a series of programs to help those suffering from chronic conditions. Included is extension of the Independence at Home program, and various telehealth measures designed to increase its provision.
Hospice: Two hospice provisions were included. 1.) Physician Assistants will now be allowed to serve as attending physicians, 2.) Patients discharged early from hospitals to hospice will now result in a reduced reimbursement to the hospital. This has the potential to limit the full effect of the hospice benefit for hospice patients.
Home Infusion: A temporary payment system will be devised and implemented by the Secretary of Health and Human Services to cover 2019 – 2021 while CMS is transitioning to a permanent structure for these services.