On November 1, 2023, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2024 Home Health Prospective Payment System (HH PPS) Rate Update final rule, which updates Medicare payment policies and rates for Home Health Agencies (HHAs). This rule includes routine updates to the Medicare Home Health PPS payment rates for CY 2024 in accordance with existing statutory and regulatory requirements. As described further below, CMS estimates that Medicare payments to HHAs in CY 2024 will increase in the aggregate by 0.8 percent, or $140 million, compared to CY 2023.
CMS is finalizing a permanent prospective payment adjustment to the CY 2024 home health 30-day period payment rate to account for any increases or decreases in aggregate expenditures as a result of the difference between assumed behavior changes and actual behavior changes, due to the implementation of the Patient-Driven Groupings Model (PDGM) and 30-day unit of payment as required by the Bipartisan Budget Act of 2018. The finalized -2.890 percent permanent adjustment is half the full permanent adjustment of -5.779 percent (-5.653 percent in the proposed rule). As a result of CMS finalizing roughly half of the full permanent adjustment projected, Medicare payments to HHAs in CY 2024 will increase in the aggregate by 0.8 percent, rather than a 2.2 percent decrease as initially proposed.
In addition, CMS is also finalizing its proposals to rebase and revise the home health market basket; revise the labor-related share; recalibrate the PDGM case-mix weights; update the low utilization payment adjustment (LUPA) thresholds, functional impairment levels, and comorbidity adjustment subgroups for CY 2024; codify statutory requirements for disposable negative pressure wound therapy (dNPWT); and establish regulations to implement payment for items and services under two new benefits: lymphedema compression treatment items and home intravenous immune globulin (IVIG). The actions CMS is taking in this final rule will help improve patient care and also protect the Medicare program’s sustainability for future generations. In addition, the final rule includes several enrollment provisions that apply to hospices as well as other provider types. We believe these provisions will help protect hospice beneficiaries by more closely scrutinizing prospective hospice owners and ensuring that newly enrolled hospices provide appropriate care to people nearing the end of life. The final rule also includes a new informal dispute resolution (IDR) process for hospice programs and a special focus program (SFP) to provide enhanced oversight of the poorest-performing hospices, building on similar oversight and enforcement programs focused on nursing homes.
Find the final rule at: https://www.federalregister.gov/public-inspection/2023-24455/medicare-program-calendar-year-2024-home-health-prospective-payment-system-rate-update-quality
Read a fact sheet on the rule at: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-home-health-prospective-payment-system-final-rule-cms-1780-f
