CMS Issues Proposed Home Health PPS Rule for 2013

The Centers for Medicare & Medicaid Services (CMS) released its proposed Home Health Prospective Payment System (PPS) Rate Update for calendar year 2013. CMS is proposing to update home health PPS rates for home health agencies (HHAs) effective January 1, 2013. The proposal would reduce payments to HHAs by 0.1%, or $20 million, for 2013. As a result of advocacy by AOTA, CMS is proposing a technical correction to revise the description of G code G0158 for occupational therapy. The revision will put in place correct terminology and be consistent with federal regulations.  The proposed rule also includes the following revisions relating to therapy reassessment visits to ensure beneficiary access to therapy services: 

  • If a reassessment visit is missed, therapy coverage would resume with the visit during which the qualified therapist completed the late reassessment rather than the visit after the therapist completed the late assessment.
  • In cases where multiple therapy disciplines are involved, if the required reassessment visit was missed for any one of the therapy disciplines for which therapy services were being provided, therapy coverage would cease only for that particular therapy discipline.
  • In cases where the patient is receiving more than 1 type of therapy, qualified therapists could complete their reassessment visits during the 11th, 12th or 13th visit for the required 13th visit reassessment and the 17th, 18th or 19th visit for the required 19th visit reassessment. 

The proposal would revise regulations to allow a nonphysician practitioner in an acute or post-acute facility to perform the home health face-to-face encounter in collaboration with or under the supervision of the physician.  The proposal would establish requirements for unannounced, standard and extended surveys of HHAs and provide a number of alternative (or intermediate) sanctions that could be imposed if HHAs were out of compliance with Federal requirements.  In addition, the proposed rule includes requirements for the hospice quality data reporting program. 

Comments are due September 4, 2012. AOTA is currently analyzing the implications of the Home Health PPS proposed rule and will be drafting comments. Please e-mail us at rrpd@aota.org with your thoughts. 

CMS Press Release: CMS Proposes Payment Changes to Medicare Home Health for 2013

Last Updated: 9/11/2012
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