Beyond The Cuts: What Else Home Health Providers Need To Know About CMS’ 2024 Final Rule
Home Health Care News | By Patrick Filbin
Nearly a month after the U.S. Centers for Medicare & Medicaid Services (CMS) released its CY 2024 final payment rule, the ins and outs of it have become more apparent. And there’s more to delve into than just blanket rate cuts.
Aside from the headline-grabbing 0.8% aggregate payment increase and the permanent prospective adjustment of -2.890%, there are dozens of other notable changes to home health care that providers should be aware of.
HHVBP program
More changes to the Home Health Value-Based Purchasing (HHVBP) model are in order.
More specifically, CMS is attempting to simplify performance scores.
“They’ve replaced the two normalized composite measures around self-care and mobility with a discharge function score,” Joseph Brence, head of clinical strategy for MedBridge, told Home Health Care News. “Additionally, the discharge community measure has been replaced with the discharge to community post-acute measure. These changes should make it easier for agencies to understand their performance without waiting for internal performance reports.”
Another positive change in value-based purchasing Brence laid out is replacing the acute care hospitalization measure – during the first 60 days of home health use – with the potentially preventable hospitalization measure.
By shifting to the latter, CMS is instead putting the focus on hospitalizations and ED usage that a home health agency would have been able to avoid. Today, an agency would be penalized every time a patient goes to the emergency room or is admitted to the hospital.
This change is narrowing the focus to what home health agencies can actually prevent, Brence said.
“That is a win for home health agencies,” Brence said. “So the attention and changes to how value-based purchasing is assessed does benefit the home health setting.”
Wage index, labor portion updates
From a revenue perspective, agencies can’t take the 0.8% increase at face value. One of the major updates every year in the final rule is the wage index value updates.
The wage index determines Medicare payments for home health services and is part of the calculation used by CMS to adjust payments based on regional variations in labor costs.
The wage index reflects the relative wage levels in the area where a home health agency is located.
There are over 450 Core-Based Statistical Area (CBSA) codes that get updated every year.
A majority of those codes — 59% — had a negative change in the final rule. Of those, 22.7% had a negative impact of over 3%.
“If you’re looking at agencies that are thinking, ‘Alright, we’re at least going to have a higher rate for next year, so we should be in the black when we do an apples-to-apples comparison,’” Nick Seabrook, managing principal and SVP of consulting at SimiTree, told HHCN. “Well, that might not necessarily be the case, based on the fact that the wage index values are going down.”
On the flip side, there were 38% that had a positive change — 10.8% had a change of 3% or higher…
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