Healthcare Provider Solutions

Are you one of The 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 Care Benefit to begin in 2016! The CMS proposed rule for Home Care 2016 was released on July 6, 2015. This rule contained the proposed details of the VBP pilot program.

To determine the participating states, the following groups were formed, with each of the 50 states being put into a group with criteria noted. The Groups are listed below with the Nine States that were “RANDOMLY” selected to participate:

Group #1: (VT, MA, ME, CT, RI, NH) ~Massachusetts~

States in this group tend to have larger HHAs and have average utilization relative to other states.

Group #2: (DE, NJ, MD, PA, NY) ~Maryland~

States in this group tend to have larger HHAs, have lower utilization, and provide care to an average number of dually-eligible beneficiaries relative to other states.

Group #3: (AL, GA, SC, NC, VA)~North Carolina~

States in this group tend to have larger HHAs, have average utilization rates, and provide care to a high proportion of minorities relative to other states.

Group #4: (TX, FL, OK, LA, MS) ~Florida~

States in this group have HHAs that tend to be for-profit, have very high utilization rates, and have a higher proportion of dually-eligible beneficiaries relative to other states.

Group #5: (WA, OR, AK, HI, WY, ID) ~Washington~

States in this group tend to have smaller HHAs, have average utilization rates, and are more rural relative to other states.

Group #6: (NM, CA, NV, UT, CO, AZ) ~Arizona~

States in this group tend to have smaller HHAs, have average utilization rates, and provide care to a high proportion of minorities relative to other states.

Group #7: (ND, SD, MT, WI, MN, IA) ~Iowa~

States in this group tend to have smaller HHAs, have very low utilization rates, and are more rural relative to other states.

Group #8: (OH, WV, IN, MO, NE, KS) ~Nebraska~

States in this group tend to have HHAs that are of average size, have average utilization rates, and provide care to a higher proportion of dually-eligible beneficiaries relative to other states.

Group #9: (IL, KY, AR, MI, TN) ~Tennessee~

States in this group tend to have HHAs with higher utilization rates relative to other states.

There is a statement in the proposed regulation that conveys that with further analysis the selections COULD possibly change before the final rule is issued later this year. If your state was selected there will be MANDATORY participation in the Value-Based Purchasing Pilot Program.

The Pilot Program is proposed 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 5% would be the payment adjustment either up or down and to increase to 6% and 8% in subsequent years. The VBP measures would be based on both achievement and improvement in quality outcomes. CMS proposes to use 10 process measures, 15 outcome measures, and 4 new measures coming from OASIS, Medicare claims data, and HHCAHPS.

Agencies, especially The Nervous Nine, must act now. This regulation is still proposed and has an open comment period through September 4, 2015. Analysis has begun with agencies across the country and comments need to be sent in, regarding these proposed changes. If you need assistance with filing your comments, contact your state home care association or the National Association of Home Care & Hospice at www.nahc.org.

The following is a link to the pdf file containing the proposed regulation:

Proposed Regulation