Home Health & Hospice Week

Don’t miss the lesser-noticed, but still important, provisions in the newly released 2025 home health proposed rule.

Take note of these topics addressed in the regulation that the Centers for Medicare & Medicaid Services issued on July 26:

1. Reduced services. In addition to proposing a new Home Health Condition of Participation requiring “patient acceptance” policies and procedures (see story, p. 173), CMS is inviting feedback on other potential CoP additions or changes to address home health service problems.

“We are seeking public comments on factors that influence the services HHAs provide, the referral process, limitations on patients being able to obtain HHA service, such as rural location and availability of staff, plan of care development, and the HHA’s communication with patients’ ordering physicians and allowed practitioners,” the rule states.

Why? “Literature shows that factors like the pandemic and ‘acuity creep’ have resulted in HHAs accepting for service much more complicated patients,” CMS says, noting the increasing prevalence of trends like hospital ICU discharges and outpatient joint replacement surgeries. “In order to protect the health and safety of all HHA patients, we seek to understand how the services offered and business operations of the HHA may influence the development and implementation of care plans,” it says.

Specific questions CMS is asking include “How do physicians and allowed practitioners use their role in establishing and reviewing the plan of care to ensure patients are receiving the right mix, duration, and frequency of services to meet the measurable outcomes and goals identified by the HHA and the patient?” and “To what extent do physicians rely on HHA clinician evaluations and reports in establishing the mix of services, service frequency, and service duration included in the plan of care?” Comments are due by Aug. 26.

2. PPEO ‘new’ clarification. CMS is looking to add a category of providers to its “new” definition for provisional period of enhanced oversight purposes.

Background: In last year’s home health rulemaking, CMS clarified the definition (see HHHW by AAPC, Vol. XXXII, No. 24-25). CMS used its PPEO authority to subject new home health agencies to Request for Anticipated Payment suppression in the last year of RAPs, and more recently it “began placing new hospices located in Arizona, California, Nevada, and Texas in a provisional period of enhanced oversight,” the rule highlights.

CMS is now “proposing to expand the definition of ‘new provider or supplier’ (solely for purposes of applying a PPEO) to include providers and suppliers that are reactivating their Medicare enrollment and billing privileges,” it says in the proposed rule scheduled for publication in the July 3 Federal Register.

Rationale: “As with a provider or supplier that voluntarily terminated its Medicare enrollment and now seeks to rejoin the program via an initial, new enrollment application, a reactivating provider, too, is requesting to rejoin the program,” CMS explains in the rule. “A reactivating provider or supplier is resuming its involvement in the Medicare program after a stoppage (which, at least for practical and operational purposes, amounts to a loss) of Medicare enrollment and billing privileges. From this standpoint, we thus believe that a reactivating provider or supplier is no less ‘new’ (for provider enrollment purposes) than one that is initially enrolling or undergoing a change of ownership,” the agency concludes.

“We believe that using a PPEO to closely monitor reactivated providers or suppliers that had been deactivated … would help prevent improper activity and help ensure program integrity where the PPEO applies,” the rule summarizes.

3. dNPWT. For CY 2025, CMS is proposing that the separate payment amount for a disposable negative pressure

wound therapy (dNPWT) device “would be set equal to the CY 2024 payment amount of $270.09 updated by the CPI-U for June 2024, minus the productivity adjustment,” as mandated by law, according to the rule.

Recap: Beginning Jan. 1, 2024, a “separate payment for a dNPWT device is made to an HHA for an individual who is under a home health plan of care using [HCPCS] code A9272,” CMS recounts in the new rule. “The HHA reports the HCPCS code A9272 for the device only on the home health TOB 32X. The services related to the application of the device are included in the home health payment and are excluded from the separate payment amount for the device.”

CMS cautions that “the application of the productivity adjustment may result in a net update that may be less than 0.0 for a year and may result in the separate payment amount for an applicable device for a year being less than such separate payment amount for such device for the preceding year.”

The agency also notes “that the CPI–U for the 12-month period ending in June of 2024 is not available at the time of this proposed rulemaking. Therefore, the CY 2025 payment amount, as well as the CPI–U for the 12-month period ending in June of 2024, and the corresponding productivity adjustment will be updated in the final rule.”

4. Long-term care facility acute respiratory illness reporting. A provision addressing COVID-19-related reporting for LTC facilities may affect home health and hospice providers down the road.

“CMS proposes replacing the current COVID-19 reporting standards for LTC facilities that sunset in December 2024 with a new standard that will address a broader range of acute respiratory illnesses,” the agency notes in its rule fact sheet. The new standard would require that, beginning on Jan. 1, 2025, facilities electronically report information about COVID-19, influenza, and respiratory syncytial virus (RSV) to the Centers for Disease Control and Prevention (CDC).

Proposed data elements would include facility census; resident vaccination status for COVID-19, influenza, and RSV; confirmed resident cases of COVID-19, influenza, and RSV (overall and by vaccination status); and hospitalized residents with confirmed cases of COVID-19, influenza, and RSV (overall and by vaccination status), the rule says. During a Public Health Emergency, reporting requirements would increase, CMS adds.

“CMS continues to believe that sustained data collection and reporting of respiratory illnesses outside of emergencies will help LTC facilities gain important insights related to their evolving infection control needs,” according to the fact sheet.

5. Home infusion. The rule contains “a proposed rate update for the CY 2025 intravenous immune globulin (IVIG) items and services’ payment under the IVIG benefit,” CMS outlines.

Remember: “A beneficiary does not have to be considered confined to the home (that is, homebound) in order to be eligible for the home IVIG benefit; however, homebound beneficiaries requiring items and services related to the administration of home IVIG, and who are receiving services under a home health plan of care, may continue to receive services related to the administration of home IVIG as covered home health services,” CMS notes in the rule.