Home Health & Hospice Week

CMS studies how it pays for costliest patients.

You won’t have an easier time accessing outlier payments in the New Year, since CMS is sticking to its guns on the FDL and loss-sharing ratio.

In its 2015 home health prospective payment system proposed rule issued in July, the Centers for Medicare & Medicaid Services proposed keeping the Fixed Dollar Loss amount (how much of the outlier cost agencies must shoulder before the outlier payments kick in) at 0.45 for 2015, and the loss-sharing ratio (Medicare’s share of the above-FDL costs) at 80 percent.

Multiple commenters asked CMS to reduce the FDL so agencies could receive more outlier funds (see Eli’s HCW, Vol. XXIII, No. 38). One commenter even suggested axing the policy altogether.

“To reduce payment rates by 5 percent and target up to 2.5 percent of total estimated HH PPS payments to be paid as outliers … is a statutory requirement and thus we do not have the authority to rescind this policy,” CMS noted in the final rule published in the Nov. 6 Federal Register.

CMS continues to study the outlier calculation, but for now it’s keeping the FDL and loss sharing ratio amounts the same for 2015, it concludes in the rule.