Home Health & Hospice Week

Activate your plans for dealing with reduced reimbursement in rural regions.

Home health agencies in rural areas will receive less financial support from Medicare just when they may need it the most.

The Centers for Medicare & Medicaid Services proposes to carry out the third year of the rural add-on phase out that was required by the Balanced Budget Act of 2018, according to the agency’s Home Health payment proposed rule for 2021 published in the June 30 Federal Register.

Reminder: In 2021, HHAs in “high utilization” rural counties will receive no add-on; HHAs in “low population density” rural counties will see a 2 percent add-on, and HHAs in all other rural counties will see a 1 percent add-on. In 2022, only agencies in low population density counties will see an add-on, and it will be reduced to 1 percent. In 2023, all rural add-ons will go away.

CMS staying the course may be proving a disappointment. “Many are not happy about the phase out and were hoping that might be slowed or eliminated in this rule,” notes consultant and physical therapist Cindy Krafft with Kornetti & Krafft Healthcare Solutions.

At least one thing that makes the add-on loss more manageable is that it “has been planned, and therefore efforts to deal with it should already be in place,” observes consultant Pam Warmack with Clinic Connections in Ruston, Louisiana. CMS first announced the four-year phase-out in its 2018 rulemaking cycle for 2019 implementation. “At least we can make plans to handle changes that we know are coming for a couple of years in advance,” Warmack says.

Note: Access a file of the rural add-on county designations is in the “Downloads” section at www.cms.gov/medicaremedicare-fee-service-paymenthomehealthppshome-health-prospective-payment-system-regulations/cms-1730-p.