Medicare 2010 Home Health PPS Rates Available by State
The Centers for Medicare & Medicaid Services (CMS) updated the Medicare home health Prospective Payment System (HH PPS) rates effective January 1, 2010. Although they were published in the
Federal Register on October 30, 2009, the rates are subject to significant change based on the fate of the health care reform bill.
“Proposals are in place to keep the 2010 rates intact and apply any changes made by the health care reform bill to 2011 and going forward; however, most home health providers have already budgeted for a 5 percent decrease in Medicare revenues for their 2010 fiscal year,” explains Gregg Hathorne, principal and home care practice leader with LarsonAllen.
He says we won’t know if the 2010 rates will change until the U.S. Senate Finance Committee presents its final plan and votes on it.
What the new rates mean for 2010
The market basket increase was lowered from the proposed rule of 2.2 percent to 2 percent in the final rule. The base rates were increased 2.5 percent by reducing the budgeted outlier fund from 5 percent to 2.5 percent and capping a provider’s outlier payments to 10 percent.
When including the third adjustment of the four-year base rate reduction of 2.75 percent for the “case mix creep,” the net increase (before geographical wage adjustments) was 1.75 percent. The national standardized base rate for non-LUPA (low utilization payment adjustment) episodes increased from $41.02 to $2,312.94. Hathorne notes that while these amounts are better than the President and MedPAC’s (Medicare Payment Advisory Commission) earlier proposals, the current health care reform bills in Congress contain payment reductions that would be devastating if implemented.
Other provisions in the final rule
Providers should carefully review the final rule because it covers stipulations beyond payment rate changes, including:
- Outcome and assessment information set (OASIS-C) rollout
- Code of practice (COP) standards for management and evaluation of a care plan (M&E) for non-skilled oversight
- Agency sales for providers operating less than 36 months
- Delay in linking Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) from 2011 to 2012
Hathorne says it’s important to note the original provision, requiring a “face-to-face encounter” between the physician and patient for any new admission or recertification was not included in the final rule, but it is in both of the House and Senate health care reform bills.
Download the 2009 HH PPS rates
To view or print the rates, choose your state from the drop-down list below.
For more information, contact Gregg Hathorne at ghathorne@larsonallen.com or 407-802-1297, or Ron Clitherow at rclitherow@larsonallen.com or 1-866-860-0816.