Home Health & Hospice Week

Reimbursement reductions that once seemed far off are getting closer.

Last year's Affordable Care Act health care reform law contained a number of Medicare reimbursement cuts for home health agencies, noted a Centers for Medicare & Medicaid Services representative at the National Association for Home Care & Hospice's recent March on Washington conference in the nation's capitol.

ACA directs CMS to reduce HHAs' market basket inflation update by 1 percent in 2012 and 2013, CMS's Lori Anderson noted in a March 28 CMS panel. And from 2014 to 2017, CMS will phase in rebasing of the home health prospective payment system.

CMS has started its rebasing analysis, but it's still early and the agency has no specific projections for reductions yet, Anderson told the standing room-only crowd. CMS does appear to assume there will be reductions and not increases based on the rebasing, industry veterans noted.

Other HHA issues Anderson discussed at the conference include:

• Access. The law calls for a study on access to home care under rebasing, as well as a possible demonstration. CMS has contracted with L&M Policy Research for this analysis, and the contractor held a March 31 Open Door Forum on the topic. (Links to information on this project is at www.cms.gov/center/hha.asp under "Open Door Forum.)

Results of this study may inform more of CMS's future policymaking, Anderson noted. It may explore other PPS issues such as incentives for therapy (the Medicare Payment Advisory Commission has advised Congress to eliminate the therapy component to PPS payment) and long stays. And the demonstration may provide a way to test new paymentproposals such as copayments.

• Case Mix Growth. CMS has been makingpayment adjustments for so-called "case mix creep" for years, but now it will have to stand behind its numbers. CMS has contracted for an independent review of its case mix growth calculations used to formulate the case mix creep payment cuts HHAs have seen every year since 2007.

Providers will see the results of the review in the 2012 proposed PPS rule, Anderson said.

• Value-Based Purchasing. CMS may berequired to issue a report on Value-Based Purchasing (formerly called Pay For Performance -- P4P) to Congress in October, but that's it for now. Legislation would have to direct CMS to implement the program, Anderson pointed out.

CMS held a Special Open Door forum on Value Based Purchasing in February (see Eli's HCW, Vol. XX, No. 9, p. 66).

• CAHPS. The Home Health Consumer Assessment of Healthcare Providers and Systems (CAHPS) program will take flight in 2012. Next year, HHAs' Medicare reimbursement levels will be impacted for the first time based on whether theyreport CAHPS data, Anderson highlighted. And public reporting of CAHPS data will also start early in the year.

Public reporting includes only data submitted after the dry run period, Anderson assured attendees. And the CAHPS survey is now available in six languages.