Any therapist considering entering the home health field should be aware of important changes happening in the industry. Right now, the major issue of focus is the proposal of the home health groupings model, or HHGM. This new payment model rolled out by the Centers for Medicare & Medicaid Services represents a dynamic shift in how patient care is organized and how home health care providers are reimbursed. If ultimately approved, HHGM would be required to go into effect at the start of calendar year 2019. Here are some more details on several areas of the model that would impact home health therapy:
Change in the unit of payment from 60-day episodes of care to 30-day periods
HHGM would mean that home health payments would be determined based on 30-day episodes of care instead of the existing 60-day period. This change could impact how care schedules are established, alter agency and staff pay flows and increase paperwork and administrative duties.
Clinical qualities given greater weight
The new payment model emphasizes the unique clinical care profiles of each individual patient, and sorts them into distinct groups for the determination of payment. As part of this shift, the contributions of therapy visits to pay would be reduced.
As the American Physical Therapy Association noted, HHGM would “eliminate therapy service use thresholds in favor of payments more focused on clinical characteristics and patient information.”
Sunset of the Rural Add-On Provision
Under the Medicare Access and CHIP Reauthorization Act, the so-called “rural add-on” provision was an “increase of 3 percent of the payment amount otherwise made for home health services furnished in a rural area, to episodes and visits ending before January 1, 2018,” according to CMS. However, under HHGM, the “sunset” of the rural add-on will take place, meaning the increase will no longer apply. This sunset equals a $100 million decrease to payments in the home health field.
Home health payment update percentage
According to forecasts by CMS, if HHGM goes into effect Medicare payments to home health agencies would be decreased by 0.4 percent in 2018. Within this reduction is a home health payment increase of $190 million, which would represent an update percentage of 1 percent.
It’s important for therapists to be aware of the changes in home health care payment both overall and as it would affect the provision of therapy services in the field. Suscribe to our blog newsletter to stay up-to-date on industry trends and changes.