What Is CMS Final Rule?

by Keith Grunig

What is CMS final rule in Home Health?

Every year, CMS issues proposes updates to its programs each year.  It starts with proposed rules, then having a comment period, and then the final rule is posted.  The final rule is essentially how CMS will manage its programs for the next year.  It includes pay rates, regulatory changes, and other policy corrections from year to year.  Typically, the proposed rule is released somewhere around July 1 with a comment period given for agencies, lobbyists, etc. to give feedback to CMS and legislators with the final rule being released usually around Oct 31- trick or treat!  

You can read the final rule here (Warning: 59 pages of light reading ahead)  2021 CMS Final Rule Home Health.

2021 Final Rule Highlights:

To Save you some reading, CMS also gives a Fact Sheet that highlights key elements of the final rule.  You can read that here (CMS Final Rule 2021 Fact Sheet)  

Here are a few of the things mentioned in the Fact Sheet.  There is a lot more than that, but a few things mentioned.

Telehealth in Home Healthcare

CMS affirmed that telehealth is really important in telehealth.  But not quite important enough to count as a reimburseable visit.  The Fact Sheet says "home health agencies (HHAs) can continue to utilize telecommunications technologies in providing care to beneficiaries under the Medicare home health benefit beyond the COVID-19 PHE, as long as the telecommunications technology is related to the skilled services being furnished, is outlined on the plan of care, and is tied to a specific goal indicating how such use would facilitate treatment outcomes."  

This does not come without a caution, however.  "The use of technology may not substitute for an in-person home visit that is ordered on the plan of care and cannot be considered a visit for the purpose of patient eligibility or payment; however, the use of technology may result in changes to the frequencies and types of in-person visits as ordered on the plan of care. This rule also proposes to allow HHAs to continue to report the costs of telecommunications technology as allowable administrative costs on the home health agency cost report beyond the PHE for the COVID-19 pandemic."  Basically, it is saying is Telehealth is important, but it's not reimbursable yet.  

National Association for Homecare and Hospice (NAHC) is urging agencies to lobby the legistlature for changes for next year (2022) to allow for telehealth to be reimbursable and count as a visit.  It is yet to be seen how this will end up, but CMS has noted that it is watching telehealth very closely and focusing on that for ADRs.   Documentation is essential for using telehealth technology.  We've discussed ADRs in a previous blog, you can read that here

Home Health Prospective Payment System Update

CMS announced a 2.6% increase for home health in 2021.  That amounts to about $540 million additional dollars.  There is a raise of 2.7% ($560 million) and a decrease of .1% for rural health addon (about $20 million). "This rule also proposes to update the home health wage index including the adoption of revised Office of Management and Budget (OMB) statistical area delineations and limiting any decreases in a geographic area’s wage index value to no more than 5 percent in CY 2021."  

Home Infustion Therapy Benefit

This is straight forward from the Fact Sheet "This rule proposes to implement Medicare enrollment policies for qualified home infusion therapy suppliers and proposes updates to the CY 2021 home infusion therapy services payment rates using the CY 2021 Physician Fee Schedule amounts."

2021 No Pay RAP

Another part of the Final Rule is the adoption of the No Pay RAP in 2021.  We have written about it extensively already, and you can read that blog (here).  This will be replaced in 2022 with the 2022 Notice of Admission.  You can read about that here (2022 NOA).  There will likely be tweaks to the NOA for the final rule.  However, usually the bulk of the proposed rule stays with minor tweaks after the comment period ends.  That is why it is essential to engage and be vocal with the legislature (both national and state) so that home health agencies get the funds and regulations that allow for optimal care for patients- because that's what it's all about.


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