Medicare Compliance & Reimbursement

Even if it’s not now, it may be by the fall.

If your state is in Medicare’s Value-Based Purchasing program for home health agencies, you’ll have to worry about your outcomes affecting your reimbursement sooner rather than later. The states proposed for inclusion are:

• Massachusetts,

• Maryland,

• North Carolina,

• Florida,

• Washington,

• Arizona,

• Iowa,

• Nebraska, and

• Tennessee.

These states may change in the final rule, the Centers for Medicare & Medicaid Services (CMS) cautions in the home health prospective payment system proposed rule released July 6. CMS “randomly” chose the states from nine geographic groupings, it says. The nine groups were based on characteristics such as agency size, utilization, and patient population characteristics.

The National Association for Home Care & Hospice criticizes CMS for failing to include “such bellwether states as California, Texas, Michigan, Illinois, and New York,” it says in a message to its members. “The pilot is also deficient in its failure to include more rural states such as Montana, Oregon, Utah, Arkansas, and Mississippi.”