Responses to these OASIS items are grouped together into response categories with similar resource use and each response category has associated points. + | 63 0 obj <> endobj 0938-1056) in order to furnish external infusion pump items. As set out at section 1834(u)(7)(C) of the Act, identified HCPCS codes for transitional home infusion drugs are assigned to three payment categories, as identified by their corresponding HCPCS codes, for which a single amount will be paid for home infusion therapy services furnished on each infusion drug administration calendar day. However, as we discussed in the proposed rule, the purpose of the proposed transition policy is to help mitigate the significant negative impacts of certain wage index changes. What you need to know about e-prescribe for HME, In this roundtable, panelists will discuss the risks and implications of using consumer apps and texting in your organizations to communicate. We note that the first quarter 2020 forecast used for the proposed home health market basket percentage increase was developed prior to the economic impacts of the COVID-19 PHE. Response: Similar to our response to a previous NPI-related comment, we encourage these commenters to review the NPI Final Rule, NPI regulations, and Medicare Expectations Subpart Paper for guidance concerning the acquisition and use of NPIs. Finally, you will need to learn how to properly document patient care. As we did not make any proposals in the CY 2021 proposed rule, we view these comments outside of the scope of this rule. Hourly rates are the easiest to set up from a payroll perspective on the administrative end. . Centers for Medicare & Medicaid Services (CMS), HHS. Additionally, while we did not outline an exhaustive list of services that are covered under the home infusion therapy services benefit, we did outline the scope of services covered under the home infusion therapy services benefit in sub-regulatory guidance. The home health payment update percentage for CY 2021 is 2.0 percent. For counties located in CBSAs and rural areas that do not correspond to a different transition wage index value, the CBSA number will still be used. Section 1895(b)(4)(B) of the Act requires the establishment of an appropriate case-mix change adjustment factor for significant variation in costs among different units of services. In the November 9, 2006 Federal Register (71 FR 65935), we published a final rule to implement the pay-for-reporting requirement of the DRA, which was codified at 484.225(h) and (i) in accordance with the statute. Local Coverage Determination (LCD): External Infusion Pumps (L33794). In the CY 2021 HH PPS proposed rule that appeared in the June 30, 2020 Federal Register (85 FR 39408), we proposed changes to the payment rates, factors, and other payment and policy-related changes to programs associated with under the HH PPS for CY 2021 and home infusion therapy services benefit for CY 2021. Bookmark | As stated in the May 2020 COVID-19 IFC, HHAs or other practitioners should check with the relevant state licensing authority websites to ensure that practitioners are working within their scope of practice and prescriptive authority. Therefore, the final CY 2021 home health payment update percentage for CY 2021 is 2.0 percent (HHA market basket percentage increase of 2.3 percent less 0.3 percentage points MFP adjustment). In order for the infusion pump to be covered under the DME benefit, it must be appropriate for use in the home (414.202). BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT. Specifically, certifications and re-certifications continue on a 60-day basis and the comprehensive assessment must still be completed within 5 days of the start of care date and completed no less frequently than during the last 5 days of every 60 days beginning with the start of care date, as currently required by 484.55, Condition of participation: Comprehensive assessment of patients.. You can choose to study to become a registered nurse right away. Appendix B of the State Operations Manual (regarding home health services) provides detailed examples of auxiliary aids and services.[7]. In addition, we implemented the establishment of regulatory authority for the oversight of national accrediting organizations (AOs) that accredit home infusion therapy suppliers, and their CMS-approved home infusion therapy accreditation programs. For home infusion therapy services effective beginning CY 2021, physicians are to continue with the current practice of discussing options available for furnishing infusion therapy under Part B and annotating these discussions in their patients' medical records prior to establishing a home infusion therapy plan of care. We take a deep dive into what's impacting employee retention and what employees are looking for in their new role. This change in methodology allows for more accurate payment for outlier episodes, accounting for both the number of visits during an episode of care and also the length of the visits provided. This commenter noted that allowing services via telecommunications technology is especially useful for certain vulnerable subsets of Medicare patients, such as cancer patients who may be immunocompromised, by helping to reduce unnecessary exposure to all illnesses, not just COVID-19. This analysis must conform to the provisions of section 604 of RFA. of this rule, we discuss the home infusion therapy supplier enrollment requirements. , click here to see all U.S. Government Rights Provisions, 26 Century Blvd Ste ST610, Nashville, TN 37214-3685. Therefore, the Secretary has determined that this final rule will not have a significant economic impact on the operations of small rural hospitals. that's excellent pay compared to our per visit rate of regular visit anywhere in the 32-35 range, add $50 to that for admission! The average hourly rate for RNs in visiting nurse associations was $37.67; for-profit agency RN hourly pay was $34.43; and not-for-profit agency pay was $36.17/hour. As such, in the CY 2021 HH PPS proposed rule, we proposed a transition in order to mitigate the resulting short-term instability and negative impacts on certain providers and to provide time for providers to adjust to their new labor market delineations. We recognize that collaboration between the ordering physician and the DME supplier furnishing the home infusion drug is imperative in providing safe and effective home infusion. The approach to calculating the LUPA thresholds under the PDGM changed to account for the 30-day unit of payment. As stated previously, we proposed that home infusion therapy suppliers be required to enroll in Medicare and pay an application fee at the time of enrollment in accordance with 424.514. establishing the XML-based Federal Register as an ACFR-sanctioned while others Specializing in the emergency room. Thus, the HH PPS statewide rural wage index is determined using IPPS hospital data from hospitals located in non-Metropolitan Statistical Areas (MSA). Payment for an infusion drug administration calendar day is a bundled payment, which reflects not only the visit itself, but any necessary follow-up work (which could include visits for venipuncture), or care coordination provided by the qualified home infusion therapy supplier. Section 1861(iii)(3)(D)(i) of the Act defines a qualified home infusion therapy supplier as a pharmacy, physician, or other provider of services or supplier licensed by the state in which supplies or services are furnished. This license will terminate upon notice to you if you violate the terms of this license. Such term does not include insulin pump systems or self-administered drugs or biologicals on a self-administered drug exclusion list. Otherwise, non-compliance could result in very expensive costs on its own. This determination is made on a drug-by-drug basis, not on a beneficiary-by-beneficiary basis. Specializes in NICU, PICU, Transport, L&D, Hospice. These commenters requested that home infusion therapy suppliers be permitted to bill all MACs from a single location: (1) Without having to maintain fixed sites in every applicable MAC jurisdiction or state; and (2) with a single National Provider Identifier (NPI). Response: We appreciate the concerns sent in by the commenters regarding the impact of implementing the New Brunswick-Lakewood, NJ CBSA designation on their specific counties. Training and education (not otherwise paid for as DME). While the pay per visit model is most prevalent for home health nursing and therapy; it is increasing with the use of telehealth in the last year and may contribute to more providers following this model. Qualified Home Infusion Therapy Suppliers and Professional Services, (4). In response to the comment regarding the new OMB delineations and the potential effect on the rural add-on payment, section 50208(a)(1)(D) of the BBA of 2018 (revising section 421 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. outlining the requirements for the claims processing changes needed to implement this payment. Overall, there are fewer Micropolitan Areas (542) under the new OMB delineations based on the 2010 Census than existed under the latest data from the 2000 Census (581). Then you have to consider the amount they would legally have to pay per mile to an employee, and the amount of miles you are driving, plus wear and tear on the car. The average turnover rate for RNs in 2019 was 20.55%; 25.85% in 2020; and 32.25% in 2021. The Affordable Care Act made additional changes to the HH PPS. However, we do not categorize post-acute care stays, meaning SNF, IRF, LTCH, or IPF stays, that occur during a previous 30-day period of care and within 14 days of a subsequent, contiguous 30-day period of care as institutional (that is, the admission date and from date for the subsequent 30-day period of care do not match), as HHAs should discharge the patient if the patient required post-acute care in a different setting, or inpatient psychiatric care, and then readmit the patient, if necessary, after discharge from such setting. For example, using the finalized CY 2021 per-visit payment rates for those HHAs that submit the required quality data, for LUPA periods that occur as the only period or an initial period in a sequence of adjacent periods, if the first skilled visit is SN, the payment for that visit would be $281.62 (1.8451 multiplied by $152.63), subject to area wage adjustment. This position is longstanding and consistent with other Medicare payment systems (for example, SNF PPS, IRF PPS, and Hospice). documents in the last year, 20 Comment: Commenters gave their overall support for PAs and advanced practice registered nurses (APRNs) to order, certify, and recertify home health services. or clean the wound. by the Housing and Urban Development Department However, each county will have only one wage index value. We received no public comments on burden estimates related to the appeals provisions and are therefore finalizing them as proposed. We believe that in the absence of home health specific wage data, using the pre-floor, pre-reclassified hospital wage data is appropriate and reasonable for home health payments. https://med.noridianmedicare.com/documents/2230703/7218263/External+Infusion+Pumps+LCD+and+PA. Services for the provision of drugs and biologicals not covered under this definition may continue to be provided under the Medicare home health benefit, and paid under the home health prospective payment system. For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services amends 42 CFR chapter IV as follows: 1. This information is not part of the official Federal Register document. (The National Supplier Clearinghouse (NSC) is the Medicare contractor that processes Form CMS-855S applications. 20-01. L. 114-10) (MACRA) amended section 421(a) of the MMA to extend the 3 percent rural add-on payment for home health services provided in a rural area (as defined in section 1886(d)(2)(D) of the Act) through January 1, 2018. In new paragraph (e)(3), we proposed that a home infusion therapy supplier may appeal the revocation of its enrollment under part 498. ++ Ensures the safe and effective provision and administration of home infusion therapy on a 7-day-a-week, 24-hour-a-day basis. However, we also recognize that some home health agencies would experience decreases in their area wage index values as a result of our proposal. documents in the last year, 11 We did not receive any comments on the LUPA add-on factors. Only eligible home infusion suppliers can bill for the temporary transitional payments. The national per-visit rates are adjusted by the wage index based on the site of service of the beneficiary. Care coordination between the physician and DME supplier, although likely to include review of the services indicated in the home infusion therapy supplier plan of care, is paid separately from the payment under the home infusion therapy services benefit. If regulations impose administrative costs on private entities, such as the time needed to read and interpret this final rule, we must estimate the cost associated with regulatory review. For CY 2021, the only urban area without inpatient hospital wage data is Hinesville, GA (CBSA 25980). For the purpose of this exclusion, the term usually means more than 50 percent of the time for all Medicare beneficiaries who use the drug. While there are some minimal impacts on certain HHAs as a result of this 5-percent cap as shown in the regulatory impact analysis of this final rule, we decided that the 5-percent cap was a better option for the transition because it would mitigate potential negative impacts from the transition to the new OMB delineations and allow providers the opportunity to adjust to the changes in their wage index values gradually. The CY 2019 HH PPS proposed rule (83 FR 32373) described the provisions of the rural add-on payments, the methodology for applying the new payments, and outlined how we categorized rural counties (or equivalent areas) based on claims data, the Medicare Beneficiary Summary File and Census data. The following is a summary of public comments received and our responses: Comment: Several commenters supported the policy to align HHVBP Model data submission requirements with any exceptions or extensions granted for purposes of the HH QRP during the PHE for COVID-19. We are not discussing these changes in this section because they are inconsequential changes with respect to the home health wage index. A Read more, A home health nurse provides health care to patients/clients. Comment: Several commenters stated that because these services cannot substitute for a home visit ordered as part of the plan of care and cannot be considered a home visit for the purposes of patient eligibility or payment, the new flexibilities will be of little benefit to HHAs and Medicare beneficiaries. High comorbidity adjustment: There are two or more secondary diagnoses on the home health-specific comorbidity subgroup interaction list that are associated with higher resource use when both are reported together compared to if they were reported separately. 553(b)). Email | These regulation changes were not time limited to the period of the COVID-19 PHE. Nurses must renew their SNB practicing certificate annually, as mentioned above. DME is excluded from the consolidated billing requirements governing the HH PPS (42 CFR 484.205) and therefore, the DME items and services (including the home infusion drug and related services) will continue to be paid for outside of the HH PPS. Home Infusion Therapy Supplier Requirements, PART 410SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS, PART 414PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES, https://www.federalregister.gov/d/2020-24146, MODS: Government Publishing Office metadata, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/coding_billing, https://www.whitehouse.gov/wp-content/uploads/2018/09/Bulletin-18-04.pdf, https://www.whitehouse.gov/wp-content/uploads/2020/03/Bulletin-20-01.pdf, https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2020-Transmittals, https://www.cms.gov/Center/Provider-Type/Home-Health-Agency-HHA-Center, whitehouse.gov/files/omb/bulletins/2017/b-17-01.pdf, https://www.whitehouse.gov/wpcontent/uploads/2018/09/Bulletin-18-04.pdf, https://www.whitehouse.gov/wpcontent/uploads/2020/03/Bulletin-20-01.pdf, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/Home-Health-Prospective-Payment-System-Regulations-and-Notices.html, https://www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/HomeHealthPPS/Home-Health-Prospective-Payment-System-Regulations-and-Notices.html, https://www.cms.gov/files/document/covid-home-health-agencies.pdf, https://www.cms.gov/files/document/guidance-memo-exceptions-and-extensions-quality-reporting-and-value-based-purchasing-programs.pdf, https://app.innovation.cms.gov/HHVBPConnect, https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Spotlight-and-Announcements, https://www.amaassn.org/practice-management/cpt/cptevaluation-and-management, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Home-Infusion-Therapy/Overview.html, https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/downloads/NPIfinalrule.pdf, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pim83c15.pdf, http://www.bls.gov/oes/current/oes_nat.htm, www.cms.hhs.gov/PaperworkReductionActof1995, https://www.bls.gov/oes/current/oes_nat.htm, https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/circulars/A4/a-4.pdf, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c10.pdf, https://downloads.cms.gov/files/hhgm%20technical%20report%20120516%20sxf.pdf, http://www.medpac.gov/docs/default-source/reports/mar20_medpac_ch9_sec.pdf, https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/bulletins/2017/b-17-01.pdf, https://www.hhs.gov/civil-rights/for-individuals/disability/index.html, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_b_hha.pdf, https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Opioid-epidemic-roadmap.pdf, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf, www.cms.gov/medicare-coverage-database/reports/sad-exclusion-list-report.aspx?bc=AQAAAAAAAAAAAA%3D%3D, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/internet-Only-Manuals-IOMs-Items/CMS014961.html, https://med.noridianmedicare.com/documents/2230703/7218263/External+Infusion+Pumps+LCD+and+PA, https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33794&ver=83&Date=05%2f15%2f2019&DocID=L33794&bc=iAAAABAAAAAA&, https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R4112CP.pdf, https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Downloads/Final-DMEPOS-Quality-Standards-Eff-01-09-2018.pdf, https://www.cms.gov/files/document/se19029.pdf. Therefore, we estimate that this rule is economically significant as measured by the $100 million threshold, and hence a major rule under the Congressional Review Act. Local Coverage Determination (LCD): External Infusion Pumps (L33794). I know some nurses who accept very low pay that I would never accept, they end up pressured to do 10+ visits a day in order to make ends meet, spending maybe 10 minutes at each visit because most of their day is travel to hit all the stops, providing low quality care. The need for the information collection and its usefulness in carrying out the proper functions of our agency. The Committee reached consensus on a methodology that resulted in the hospice wage index. In addition, this section of the BBA of 2018 made some important changes to the rural add-on for CYs 2019 through 2022. Section 1895(b)(3)(A)(i) of the Act requires that the standard prospective payment rate and other applicable amounts be standardized in a manner that eliminates the effects of variations in relative case-mix and area wage adjustments among different home health agencies in a budget-neutral manner. Section 1895(b)(5) of the Act allows for the provision of an addition or adjustment to the home health payment amount otherwise made in the case of outliers because of unusual variations in the type or amount of medically necessary care. Moreover, it is possible for the principal diagnosis to change between the first and second 30-day period of care and the claim for the second 30-day period of care would reflect the new principal diagnosis. Comment: Several commenters inquired about CMS's utilization of data from the last performance year of the Model (CY 2020). Therefore, it is anticipated that HHAs have sufficient payment to account for the costs of PPE. We thus proposed to include home infusion therapy suppliers within the limited screening category. 10/29/2020 at 4:15 pm. [19] This payment covers the same items and services as defined in section 1861(iii)(2)(A) and (B) of the Act, furnished in coordination with the furnishing of transitional home infusion drugs. The data used to categorize each county or equivalent area are available in the downloads section associated with the publication of this rule at: https://www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/HomeHealthPPS/Home-Health-Prospective-Payment-System-Regulations-and-Notices.html. Any of the reasons for denial of a prospective provider's or supplier's enrollment application in 424.530 applies. ++ Is enrolled in Medicare as a home infusion therapy supplier consistent with the provisions of 424.68 and part 424, subpart P. In paragraph (b), we proposed that for a supplier to receive Medicare payment for the provision of home infusion therapy supplier services, the supplier must: (1) Qualify as a home infusion therapy supplier (as defined in 424.68); and (2) be in compliance with all applicable provisions of 424.68 and part 424, subpart P. (Proposed paragraph (b) would achieve consistency with 424.505, which states that all providers and suppliers seeking to bill Medicare must enroll in Medicare and adhere to all of subpart P's enrollment requirements.). State Operations Manual Appendix BGuidance to Surveyors: Home Health Agencies, Tab G490. In a comparison of rates by agency type, RNs in hospital-based home health agencies received the highest in pay with an average hourly rate of $40.10. Follow-up services to the beneficiary and/or caregiver(s), must be consistent with the type(s) of equipment, item(s) and service(s) provided, and include recommendations from the prescribing physician or healthcare team member(s). As provided at section 1895(b)(3)(B)(vi) of the Act, depending on the market basket percentage increase applicable for a particular year, the reduction of that increase by 2 percentage points for failure to comply with the requirements of the HH QRP and further reduction of the increase by the productivity adjustment (except in 2018 and 2020) described in section 1886(b)(3)(B)(xi)(II) of the Act may result in the home health market basket percentage increase being less than 0.0 percent for a year, and may result in payment rates under the Home Health PPS for a year being less than payment rates for the preceding year. For CY 2021, we proposed to maintain the same fixed-dollar loss ratio finalized for CY 2020. Wage index addenda will be available only through the CMS Coding and Billing Information website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/coding_billing. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. Comment: A commenter recommended that CMS consider applying a PHE policy that was established for skilled nursing facilities to the Part A home health benefit, which would allow services provided on the premises, though not necessarily in the same room as the patient, to be considered in-person services. That is to say, the law required that CMS calculate the 30-day payment amount for CY 2020 to ensure that the aggregate expenditures during CY 2020 under the new case-mix methodology and 30-day unit of payment would be the same as if the 153-group model was still in place in CY 2020. The quality, utility, and clarity of the information to be collected. Therefore, in the CY 2020 HH PPS final rule with comment period, we noted that the infusion pump, drug, and other supplies, and the services required to furnish these items (that is, the compounding and dispensing of the drug) remain covered under the DME benefit. Therefore, the commenter is concerned that agencies could be at risk for missing the 5-day window while seeking to confirm a beneficiary's insurance coverage. In aggregate, we estimated a burden of 1,750 hours (1,500 hrs + 125 hrs + 125 hrs) at a cost of $85,750. Section 4603(a) of the BBA mandated the development of a HH PPS for all Medicare-covered home health services provided under a plan of care (POC) that were paid on a reasonable cost basis by adding section 1895 of the Act, entitled Prospective Payment for Home Health Services. Section 1895(b)(1) of the Act requires the Secretary to establish a HH PPS for all costs of home health services paid under Medicare. However, based on feedback received from the home infusion therapy community, we are confident that an adequate number of suppliers will enroll in Medicare, therefore helping to ensure beneficiary access to these services.

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