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CMS issued the Home Health Final Rule for 2016 and while the Value Based Purchasing (VBP) is a huge deal, agencies do not need to overlook the reimbursement impact of the rate changes, wage index adjustments and case mix creep adjustment!

The following is a recap of the rate changes:

    • Episode rates: full cut (3.5% of 2010 rates) – Year 3 Rebasing
    • Case Mix Creep Adjustment – 0.97% – 2016, 2017, 2018
  • LUPA per visit rates: full increase
    • – Home Health Aide: $60.87
    • – MSW: $215.47
    • – OT: $147.95
    • – PT: $146.95
    • – SLP: $159.71
    • – SN: $134.42
    • – Non‐routine Medical Supplies: 2.82% reduction
  • Recalibrated case mix weights
  • New CBSAs
  • Wage Index Updates
  • Outlier eligibility remains same
  • Rates reduced by 2% if no quality data submitted
  • 3% rural add‐on continues through 2017
  • Remember 2% payment sequestration

In addition to the HHRG point structure being revamped again, the case mix weights are to be adjusted, as well and that is for all 153 HHRGs.

The 60 Day Episodic Base rate is set at $2,965.12 for 2016, which is up from $2,961.38, but do not be taken in by that. The reductions are all there, but in the form of the case mix weight changes to the 153 HHRGs. In addition, there have also been more changes to the point scoring for the OASIS C1 items that make up the calculation of the HHRG.

Regarding the CBSA changes: Agencies should be aware that the temporary CBSA codes utilized for many codes in 2016 will revert to there permanent codes January 1, 2016. So episodes that have a claim with a visit dated January 1. 2016 or later the 2016 CBSA code must be utilized on the claim.

Be watching for the updated 2016 PPS HHRG Tables to be updated on our website.

Following is a link to the final regulation and ensure that you are using the updated tables for analysis that CMS published at this link:

Final Regulation