CMS Home Health, Hospice & DME Open Door Forum

Session Updated Information on 2013 HHPPS Final Rule

The Centers for Medicare & Medicaid Services held its latest Home Health, Hospice, and Durable Medical Equipment (DME), Prosthetics, and Orthotics Open Door Forum on Nov. 28, that updated information on the 2013 home health prospective payment (HHPPS) final rule, Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS), home health and hospice quality measure reporting, and hospice claims processing issues.

HHPPS Final Rule

A final rule was published in the Nov. 8th Federal Register to update Medicare’s Home Health Prospective Payment System (HH PPS) payment rates for Calendar Year (CY) 2013. Payments to home health agencies (HHAs) are estimated to decrease by approximately 0.01 percent for CY 2013, reflecting the combined effects of the home health payment update, a new fixed dollar loss ratio, and reductions to the HH PPS to account for a 1.32 percent case-mix coding adjustment.

In addition, the final rule revises requirements to the therapy documentation and reassessments as well as face-to-face encounter requirements, discusses the transition plan for ICD-10 and diagnosis coding changes. Lastly, this rule implements new requirements concerning the hospice quality reporting program and will establish requirements for unannounced, standard, and extended surveys of home health agencies (HHAs) and provide a number of alternative (or intermediate) sanctions that could be imposed if HHAs were out of compliance with Federal requirements.

Specifically, CMS revised the face to face requirement so as not to be prescriptive as to which entity may title the face to face document. The rule also allows for an NPP who conducts the face to face encounter that is working with the inpatient physician to communicate the findings to that physician who will then communicate the findings to the certifying physician.

Three key revisions to the therapy requirements in the final rule are as follows:

  • Revised the regulations to state that if a qualified therapist missed a reassessment visit, therapy coverage would resume with the visit during which the qualified therapist completed the late reassessment, not the visit after the therapist completed the late reassessment.
  • Revised the regulations where in cases where multiple therapy disciplines are involved, if the required reassessment visit was missed for any one of the therapy disciplines for which therapy services were being provided, therapy coverage would cease only for that particular therapy discipline.
  • Revised the regulations to clarify that in cases where the patient is receiving more than one type of therapy, qualified therapists must complete their reassessment visits during the 11th,12th, or 13th visit for the required 13 th visit reassessment and the 17th, 18th, or 19th visit for the required 19th visit reassessment.

The final rule revises the calculation of acute care hospitalization (ACH) measure. The ACH measure will be based on claims data rather than the OASIS. The January refresh for Home Health Compare will include the claim based ACH measure.

The payment rate and other policy updates in the final rule will apply to episodes that end on or after January 1, 2013, except the therapy revisions, Changes to the therapy reassessment policy will be applied to episodes that begin on or after January 1, 2013.

Grouper V3413 that reflects payment changes for V-code diagnosis assignment, as outlined in the final rule, is now available for download and apply to assessments with a complete date on or after Jan 1, 2013. Click here for more info.


All HH CAHPS announcements will be posted on the HH CAHPS home web page at HHAs that served 59 or fewer unduplicated patients from April 1, 2011 through March 31, 2012 are exempt from the HHCAHPS requirements for 2014. Agencies are reminded that exemptions must be filed by 1/17/2013. Agencies must authorize their vendors on the HH CAHPS website and should check to see if their data is being submitted. Agencies may access their reports by logging into the HH CAHPS website using their administrator credentials. Vendor must submit 3rd quarter data by 1/17/2013.

A webinar training session will take place on January 30, 2013. Although the training sessions are intended for vendors, providers are welcome to participate.

Outcome and Assessment Information Set (OASIS)

CMS has posted a new OASIS web based training module for the Patient Tracking domain. To access the module, click here and select “ I AM A PROVIDER ”option, select “Web based training” scroll down to 6th item and select OASIS Training, select “Launch the Course”, select desired module. CMS is interested in provider feedback on the OASIS training modules and requests that viewers click here to send feedback.

The next Open Door Forum is scheduled for January 9, 2013.

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