Last Updated on

Are you one of The Confirmed Nervous Nine? The Nervous Nine are the Nine States that have been selected for the Value-Based Purchasing (VBP) Pilot Program under the Medicare Home Health Benefit to begin in 2016! The CMS FINAL rule for home health 2016 was released on October 29, 2015. This rule contained the final details of the VBP pilot program.

Following are the states that have MANDATORY participation requirements: Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska and Tennessee!

The Pilot Program has been finalized to use CY 2015 as the base year and the first performance year would be CY 2016. Beginning with Jan-Mar 2016, they propose to issue quarterly reports so that agencies can monitor progress, with the first report being available July 2016. The first payment affect of this program will be January 2018 for the results of 2016. The proposal is that a maximum of 3% would be the payment adjustment either up or down and to increase to 5%, 6%, 7% and 8% in subsequent years.

The VBP measures were updated in the final rule to include the following:

Outcome Measures:

1. Improvement in Ambulation- Locomotion

2. Improvement in bathing

3. Improvement in bed transferring

4. Improvement in dyspnea

5. Discharged to Community

6. Acute Care Hospitalization: Unplanned Hospitalization during first 60 days of Home Health

7. Emergency Department Use without Hospitalization

8. Improvement in Pain Interfering with Activity

9. Improvement in Management of Oral Medications

10. Prior Functioning ADL/IADL

Process Measures:

1. Care Management: Types and Sources of Assistance

2. Influenza Vaccine Data Collection Period: Does this episode of care include any dates on or between October 1 and March 31?

3. Influenza Immunization Received for Current Flu Season

4. Pneumococcal Polysaccharide Vaccine Ever Received

5. Reason Pneumococcal vaccine not received

6. Drug Education on All Medications Provided to Patient/Caregiver during all Episodes

Home Health CAHPS: Satisfaction Survey Measures:

1. Care of Patients (CAHPS )

2. Communications between Providers and Patients (CAHPS)

3. Specific Care Issues (CAHPS)

4. Overall rating of home health care (CAHPS)

5. Willingness to recommend the agency (CAHPS)

New Measures:

1. Influenza Vaccination Coverage for Home Health Care Personnel

2. Herpes zoster (Shingles) vaccination: Has the patient ever received the shingles vaccination?

3. Advance Care Plan

New Measures scores included in the final Total Performance Score for PY1 are only based on whether the HHA has submitted data to the HHVBP web-based platform or not. In consideration of the comments received, CMS is finalizing this New Measure as proposed, with the modification that HHAs will be required to begin reporting data no later than October 7, 2016 for the period July 2016 through September 2016 and quarterly thereafter. As a result, the first quarterly performance report in July 2016 will not account for any of the New Measures.

Our next blog will discuss the reimbursement changes for 2016 and further discuss specifics of VBP for weeks to come.

Following is a link to the final rule:

Final Rule