Advanced Search

Home Health & Hospice Week

Regulations:

PPS Payment Changes On Their Way

Published on Tue May 04, 2004

Home health agencies won't see the same old payment rate updates this summer.
 
The Centers for Medicare & Medicaid Services plans a revamp of the prospective payment system, the first since PPS was implemented in October 2000. But it will be a "routine" and "minor" update, a CMS official maintained in the April 28 Open Door Forum for home health.

The main change will be the calculation of the market basket index, which is the inflation factor used to update payment rates.

When CMS refigured hospitals' MBI last year, it translated to a 0.01 increase, the official explained.

But HHAs will have to face the 0.08 reduction to the MBI required by the Medicare Modernization Act passed last December, in addition to whatever changes CMS comes up with, the CMS staffer reminded listeners.

The National Association for Home Care & Hospice is hoping for a few more changes in the proposed rule, which is expected by the end of May. NAHC would like to see a change to the PPS outlier formula, which is supposed to pay extra for patients who require very heavy services. And NAHC wants CMS to implement the wage index changes the Office of Management and Budget issued last June (see Eli's HCW, Vol. XII, No. 23).

The proposed rule should implement the MMA provision that changes the HHA payment update date from Oct. 1 to Jan. 1, NAHC adds.

Other topics covered in the forum include:

  • MSP. Come July, you may see slight over- and underpayments corrected, CMS forewarned. Medicare Secondary Payor software has been incorrectly calculating MSP amounts, and a July update will fix the problem as well as former mistakes. The "basic effect of that will be a wash," but agencies are likely to wonder where the slight adjustments on their remittance advices are coming from, CMS said.

  • Electromagnetic therapy. Electromagnetic wound care therapy is covered in the home health setting, and therefore does count toward M0825, CMS confirmed in the forum (see Eli's HCW, Vol. XIII, No. 12). Physical therapists must furnish the service.

  • Drug cards. The new Medicare discount drug cards don't relieve hospices of their responsibility for covering drugs related to the terminal illness, CMS said.

    And if you're unsure how to help your patients use the drug card, you can check out materials for providers at     www.cms.hhs.gov/medlearn/drugcard.asp.

    • Other Articles in this issue of

    Home Health & Hospice Week

    View All