The Centers for Medicare & Medicaid Services (CMS) has published 2014 rates and other revisions for the home health agency (HHA) prospective payment system (PPS).
- The base fee per 60-day episode in 2014 will be $2,869 (prior to geographic adjustment), a decrease by an average of 1%, with a 3% add-on for rural HHAs.
- As always, if there are fewer than five total home health visits in an episode, the episode payment is substituted by a fixed payment per visit based on historic per-visit costs by discipline. The 2014 per-visit rate, known as low-utilization payment adjustment (LUPA), is $143.88 for speech-language pathologists (SLPs), compared with $132.40 for physical therapists (PT) and $133.30 for occupational therapists (OT), geographically adjusted. These rates represent a 5.9% increase for each discipline. SLP rates in this category have surpassed PT/OT rates over the past 2 decades.
- Two categories of ICD-9 codes (total of 170) have been removed from the OASIS assessment system that helps to determine specific episodic rates. One category includes codes that represent conditions "too acute" to be appropriately cared for in an HHA setting. The other category includes codes that reflected conditions that do not require HHA intervention.
- The rule finalizes new quality measures for unnecessary hospital readmissions and preventable trips to the emergency room.
Rates are not based on analyses of HHA cost and service utilization data because of the Affordable Care Act (ACA). Instead, they are determined by the mix of services in an episode, the level of intensity of services, the average cost for providing care per episode, and other factors, in addition to the total number of visits. The ACA requires CMS to begin phasing in adjustments to the national standardized 60-day episode payment rate based on these cost factors. Payments for each episode expand based on tiered increases in therapy visits. In addition, CMS is authorized to establish demonstration projects to test how HHAs provide access to care. A report to Congress is due by March 1, 2014, to make recommendations for legislation or administrative action, if needed.
Regarding the slight decrease in the 2014 episodic rate, CMS stated that it "will vigilantly monitor payment claims and other metrics to ensure that access remains strong as we phase-in this new payment adjustment."
SLP visits represented 1.1% of all HHA visits in 2011, or 1.34 million visits. The HHA scope of coverage is for speech-language pathology, physical therapy, occupational therapy, and nurse, aide, and social worker visits.
For questions related to home health services, please contact Mark Kander, ASHA's director of health care regulatory analysis, at [email protected], or a member of the health care economics and advocacy team, at [email protected].