Home Health & Hospice Week

Clock will start ticking on 30-day recalculation requests.

CMS may not have announced the results for Value-Based Purchasing yet, but it’s gearing up to dock — or boost — agencies’ payments for the program in its nine demo states.

Medicare will adjust claims a maximum of 3 percent in calendar year 2018, 5 percent in CY 2019, 6 percent in CY 2020, 7 percent in CY 2021, and 8 percent in CY 2022, the Centers for Medicare & Medicaid Services reminds in a new MLN Matters article about the changes contained in CR 10167.

CMS has directed the HHH Medicare Administrative Contractors to make changes to the payment system to accommodate those adjustments.

For example: “MACs will place the HH VBP adjustment amount on the claim as a value code QV amount,” the article says. “This may be a positive or a negative amount.”

Review: “For all Medicare-certified HHAs that provide services in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington, payment adjustments will be based on each HHA’s total performance score on a set of measures already reported via the Outcome and Assessment Information Set (OASIS) and the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) for all patients serviced by the HHA, or determined claims data, in addition to three new measures where performance points are achieved for reporting data,” CMS says.

VBP launched in the nine states in January 2016, and it is the data from that year that will determine the 2018 payment adjustments. CMS has been very secretive about its VBP procedures and results, limiting access to participation information by excluding software and billing vendors, industry representatives and advocates, news media, and other usual participants from its VBP events and resources.

Heads up: CMS did announce in its Aug. 9 Home Health Open Door Forum that VBP agencies’ first Total Performance Score preview reports would be available by the end of August. VBP agencies can access their reports via the HHVBP Connect website, a CMS official said.

Those reports will also include agencies’ payment adjustment amounts, CMS indicated in its 2016 HH PPS final rule. Going forward, VBP agencies will receive their annual preview reports in August and have 30 days to request recalculations, with CMS finalizing the report results by Nov. 1 — two months before the payment adjustments take effect.

CMS will also hold a webinar about the reports on Aug. 31, the staffer added.

Starting in 2019, CMS may switch to revising VBP payment adjustments every six months, it suggested in the 2016 final rule. “We would expect that having payment adjustments transpire closer together through more frequent performance periods would accelerate improvement in quality measures because HHAs would be able to justify earlier investments in quality efforts and be incentivized for improvements,” CMS theorized in the rule.

If CMS decides to switch to the six-month adjustment calendar, it will notify agencies via rulemaking, it said.

CMS has made other changes to the program since its launch, with somewhat minor revisions included in each of the payment rules issued since then.

Note: See the MLN Matters article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10167.pdf.