CMS Posts Home Health Cost Report Changes

The Centers for Medicare & Medicaid Services has posted home health cost report changes online. The changes modify the instructions and existing worksheets to reflect a series of refinements that address sequestration and matters related to Federally-Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). It is expected that CMS will release further cost report changes affecting home health agency-based hospice soon, as well.

The significant revisions are outlined below:

  • Worksheet S-4: Adds column 3, line 16 to capture total visits performed by interns and residents to facilitate the calculation of allowable graduate medical education (GME) pass-through costs incurred by a home health agency (HHA) based rural health clinic (RHC) and federally qualified health center (FQHC).
  • Worksheet D, Part I: Clarifies the instructions for line 1.
  • Worksheets D, Part II; CM-3, Part II; and RF-3: Added or revised lines or instructions as applicable to accommodate the 2 percent Medicare sequestration adjustment, as indicated in the Office of Management and Budget Report to the Congress on the sequestration required by section 251A of the Balanced Budget and Emergency Deficit Control Act, as amended by the Joint Committee. The sequestration adjustment is effective for portions of cost reporting periods that overlap or begin on or after April 1, 2013.
  • Worksheet D, Part II:  Revised instructions for line 19. This line is now shaded on the worksheet.
  • Worksheets D, Part II; CM-3, Part II; and RF-3: Adds lines to section 3201(c) of the Middle Class Tax Relief and Job Creation Act of 2012 which reduces bad debts by 12 percent for cost reporting periods that begin on or after October 1, 2012, 24 percent for cost reporting periods that begin on or after October 1, 2013, and 35 percent for cost reporting periods that begin on or after October 1, 2014.
  • Worksheet CM-3, Part II: Adds line 17.01 and 17.02, respectively, to accommodate adjusted reimbursable bad debts and allowable bad debts for dual eligible beneficiaries.
  • Worksheet RF-1, RF-2 and RF-3: Revises the worksheets to incorporate the payment of allowable GME costs for HHA based RHCs and FQHCs pursuant to 42 CFR 405.2468(f)(2).
  • Worksheet RF-2: Adds lines 7.01, Medical Nutrition Therapist, and 7.02, Diabetes Self-Management Training, as new position categories to facilitate the collection of full time equivalent and visit data for FQHCs.
  • Worksheet RF-3: Adds lines 16.01 through 16.05 to implement section 4104 of the Patient Protection and Affordable Care Act which eliminates coinsurance and deductible for preventive services furnished by HHA based for RHCs and FQHCs, effective for dates of service on or after January 1, 2011. Adds line 22.01 and 22.02 to accommodate adjusted reimbursable bad debts and allowable bad debts for dual eligible beneficiaries, respectively.

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