CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. The HHCAHPS has five component questions that together are used to represent one NQF-endorsed measure. (ii) All care provided must be in accordance with the plan of care. The separate payment for infusion drug Start Printed Page 70331administration in an HOPD and in a physician's office generally includes a base payment amount for the first hour and a payment add-on that is a different amount for each additional hour of administration. We will repost the LUPA thresholds (along with the case-mix weights) that will be used for CY 2021 on the HHA Center and PDGM web pages. (However, we interpret this latter provision to apply strictly to the establishment of standards of care as opposed to the creation of enrollment requirements for home infusion therapy suppliers.) Physician visits including but not limited to mental health and maternity. on High comorbidity adjustment: There are two or more secondary diagnoses on the home health-specific comorbidity subgroup interaction list that are associated with higher resource use when both are reported together compared to if they were reported separately. Section 1861(iii)(3)(C) of the Act defines home infusion drug as a parenteral drug or biological administered intravenously, or subcutaneously for an administration period of 15 minutes or more, in the home of an individual through a pump that is an item of durable medical equipment (as defined in section 1861(n) of the Act). Comment: A few commenters, including MedPAC, suggested alternatives to the 5 percent cap transition policy. 1503 & 1507. The second column shows the number of facilities in the impact analysis. Section 409.64 is amended by revising paragraph (a)(2)(ii) to read as follows: (ii) The hospital, CAH, SNF, or home health agency had submitted all necessary evidence, including physician or allowed practitioner certification of need for services when such certification was required; 6. We stated that, consistent with the definition of home infusion therapy, the home infusion therapy services payment explicitly and separately pays for the professional services related to the administration of the drugs identified on the DME LCD for External Infusion Pumps (L33794),[17] Therefore, we proposed to remove the requirement at 484.45(c)(2). This process may occur any time within the 12-month timely filing period for the acute or post-acute claim. We Start Printed Page 70328would like to note that in the CY 2020 Home Health PPS final rule with comment period (84 FR 60592 through 60594), CMS finalized the Pain Interference (Pain Effect on Sleep, Pain Interference with Therapy Activities, and Pain Interference with Day-to-Day Activities) data elements as standardized patient assessment data elements This will allow HHAs to continue to collect information on patient pain that could support care planning, quality improvement, and potential quality measurement, including risk adjustment. 553(b)(B)). So then you have to start looking at how you move those chess pieces around to get everybody what they need.. The Medicare National Coverage Determinations Manual, chapter 1, part 4, section 280.14 describes the types of infusion pumps that are covered under the DME benefit. Current System for Payment of Home Health Services Beginning in CY 2020 and Subsequent Years, III. Likewise, home infusion therapy services related to the intrathecal administration of morphine, identified by HCPCS code J2274, is excluded because intrathecal administration does not meet the definition of a home infusion drug under the permanent benefit. documents in the last year, 1479 Commenters stated that behavior change would not occur 100 percent of the time for all 30-day periods of care. Final Decision: We did not propose any changes, therefore we are maintaining the current definition of home infusion drugs as finalized in the CY 2020 HH PPS final rule with comment period (84 FR 60618), pursuant to the statutory definition set out at section 1861(iii)(3)(C) of the Act, and incorporated by cross reference at section 1834(u)(7)(A)(iii) of the Act. Comment: A commenter expressed support for our proposal in 424.68(b)(3) that a home infusion therapy supplier must be accredited in order to enroll in Medicare. Response: We thank the commenter for their support. CDT is a trademark of the ADA. An outlier payment as set forth in 484.205(d)(3) and 484.240. For information about the Home Health Quality Reporting Program (HH QRP), send your inquiry via email to HHQRPquestions@cms.hhs.gov. Services for the provision of drugs and biologicals not covered under this definition may continue to be provided under the Medicare home health benefit, and paid under the home health prospective payment system. 1. Section 1895(b)(3)(B)(v) of the Act requires that the home health payment update percentage be decreased by 2.0 percentage points for those HHAs that do not submit quality data as required by the Secretary. (The National Supplier Clearinghouse (NSC) is the Medicare contractor that processes Form CMS-855S applications. Response: Section 1895(b)(5)(A) of the Act allows the Secretary the discretion as to whether or not to have an outlier policy under the HH PPS. allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 These commenters stated that the impact on payment to home health agencies would make it highly unlikely that Medicare home health spending in CY 2020 would be budget neutral in comparison to the level of spending that would have occurred if the PDGM and the change to a 30-day unit of payment had not been implemented. For rural areas that do not have inpatient hospitals, we proposed to use the average wage index from all contiguous Core Based Statistical Areas (CBSAs) as a reasonable proxy. Specifically, for CY 2021 as a transition, we proposed to apply a 5 percent cap on any decrease in a geographic area's wage index value from the wage index value from the prior calendar year. T1001EP Authorized Nurse Visit - HCY (per visit) $44.35 $44.35 $46.69 T1001TDEP RN evaluation visit for PC - HCY (per documents in the last year, 83 Comment: A few commenters noted that, while helpful for many home health patients, especially those with chronic conditions, CMS should put safeguards in place to ensure that in-person visits are not being replaced by telecommunications technology and that in-person visits remain at adequate levels. The supplier sends its personnel out from this site to perform services in States X, Y, and Z; each of these states falls within a different MAC jurisdiction. and meet the definition of a home infusion drug with coverage of home infusion therapy services under payment category 2. We also realize that many home health agencies would have higher area wage index values under the new OMB delineations. One clinician could make six visits in a relatively short amount of time, while another may have to travel hundreds of miles to get to six different visits, Griffin explained. Section 421(a) of the MMA, as amended by section 3131 of the Affordable Care Act, requires that the Secretary increase, by 3 percent, the payment amount otherwise made under section 1895 of the Act, for home health services furnished in a rural area (as defined in section 1886(d)(2)(D) of the Act) with respect to episodes and visits ending on or after April 1, 2010, and before January 1, 2016. Comment: Nearly all commenters supported the proposed 2.7 percent increase for a market basket update. The following is our response. Reporting Under the HHVBP Model for CY 2020 During the COVID-19 PHE, A. Medicare Coverage of Home Infusion Therapy Services, (d) Summary of CY 2019 and CY 2020 Home Infusion Therapy Provisions, 2. These flexibilities include: These flexibilities were provided to help mitigate commenters' concerns about the provision of home health services during the COVID-19 PHE. When the Medicare claims processing system receives a Medicare home health claim, the systems check for the presence of a Medicare acute or post-acute care claim for an institutional stay. Section 1895(b)(3)(B) of the Act addresses the annual update to the standard prospective payment amounts by the applicable home health percentage increase. I do live in Mississippi btw. Fourth, sections 1102 and 1871 of the Act furnish general authority for the Secretary to prescribe regulations for the efficient administration of the Medicare program. The home infusion therapy supplier does not meet all of the requirements for enrollment outlined in 424.68 and in part 424, subpart P of this chapter; or. This decrease reflects the exclusion of statutorily-excluded drugs and biologicals, and is representative of a wage-adjusted 4-hour payment rate, compared to a wage-adjusted 5-hour payment rate. To mitigate the potential impacts of proposed policies on home health agencies, we have in the past provided for transition periods when adopting changes that have significant payment implications, particularly large negative impacts. Comment: A commenter recommended that CMS consider applying a PHE policy that was established for skilled nursing facilities to the Part A home health benefit, which would allow services provided on the premises, though not necessarily in the same room as the patient, to be considered in-person services. 5. Next, we update the 30-day payment rate by the CY 2021 home health payment update percentage of 2.0 percent. In addition, for both the submission of the RAP in CY 2021 and the one-time NOA for CYs 2022 and subsequent years, we finalized a payment reduction if the HHA does not submit the RAP for CY 2021 or NOA for CYs 2022 and subsequent years within 5 calendar days from the start of care. Response: Similar to our response to a previous NPI-related comment, we encourage these commenters to review the NPI Final Rule, NPI regulations, and Medicare Expectations Subpart Paper for guidance concerning the acquisition and use of NPIs. $0 for covered home health care services. However, this will result in some adjusted payments being higher than the average and others being lower. We acknowledge, however, that two immune-globulins, Xembify and Cutaquig, have been added to the DME LCD for External Infusion Pumps (L33794). We apply the wage index budget neutrality factor of 0.9999 to the calculation of the CY 2021 national, standardized 30-day period payment rate. There are some drugs that are paid for under the transitional benefit but would not be defined as a home infusion drug under the permanent benefit beginning with 2021. In the CY 2019 HH PPS final rule with comment period (83 FR 56406), we finalized the implementation of temporary transitional payments for home infusion therapy services to begin on January 1, 2019. Additionally, section 1861(iii)(1)(B) of the Act requires that the patient be under a plan of care established and periodically reviewed by a physician, in coordination with the furnishing of home infusion drugs. emphasizes non-pharmacological options for managing pain as critical in the efforts to reduce over-reliance on and misuse of opioids. We stated that although section 1895(e)(1)(A) of the Act prohibits payment for services furnished via a telecommunications system if such services substitute for in-person home Start Printed Page 70323health services ordered as part of a plan of care, we understand that there are ways in which technology can be further utilized to improve patient care, better leverage advanced practice clinicians, and improve outcomes while potentially making the provision of home health care more efficient. To clarify the effective date of billing privileges for home infusion therapy suppliers and to account for circumstances that could prevent a home infusion therapy supplier's enrollment prior to the furnishing of Medicare services, we proposed to include newly enrolling home infusion therapy suppliers within the scope of both 424.520(d) and 424.521(a). Historically, payments under the HH PPS have been higher than costs, and in its March 2020 Report to Congress, MedPAC estimates HHAs to have projected average Medicare margins of 17 percent in 2020. headings within the legal text of Federal Register documents. term variability of LUPA thresholds, CMS is proposing to maintain LUPA thresholds finalized in the CY 2020 final rule. The wage index file posted on the CMS website provides a crosswalk between each state and county and its corresponding wage index along with the previous CBSA number, the new CBSA number or alternate identification number, and the new CBSA name. 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