It also mandated implementation of a new methodology for applying those payments. With that in mind, providers need to find one model that works for both employees and their bottom line. For more in-depth information regarding the finalized policies associated with RAPs and the new one-time NOA process, we refer readers to the CY 2020 HH PPS final rule with comment (84 FR 60544). In the event that the no-pay RAP is not timely-filed, the penalty is calculated from the first day of that 30-day period (in the example, the penalty calculation would begin with the start of care date of January 1, 2021, counting as the first day of the penalty) until the date of the submission of the no-pay Start Printed Page 70319RAP. Comment: A commenter remarked on the proposed FDL ratio of 0.63 that was in the CY 2021 HH PPS proposed rule and stated that the FDL ratio that was finalized for CY 2020 was 0.56. They address, among other things, requirements that providers and suppliers must meet to obtain and maintain Medicare billing privileges. $0 for covered home health care services. As for home infusion therapy suppliers that subcontract the provision of certain services to another party, the enrolled supplier is ultimately responsible for ensuring that it meets and operates in compliance with all Medicare requirements, enrollment or otherwise. Any requests regarding additions to the DME LCD for External Infusion Pumps must be made to the DME MACs. Section 424.68 is added to subpart E to read as follows: (a) Definition. Therefore, we proposed to maintain the PDGM case-mix weights finalized and shown in Table 16 of the CY 2020 HH PPS final rule with comment period (84 FR 60522) for CY 2021 payment purposes. LEARN MORE. In the May 2020 COVID-19 IFC, we explained that the HHVBP Model utilizes some of the same quality measure data that are reported by HHAs for the HH QRP, including HHCAHPS survey data. Fires, floods, earthquakes, or similar unusual events that inflict extensive damage to the home health agency's ability to operate. For CY 2021, we proposed to maintain the same fixed-dollar loss ratio finalized for CY 2020. To better align payment with patient care needs and ensure that clinically complex and ill beneficiaries have adequate access to home health care, in the CY 2019 HH PPS final rule with comment period (83 FR 56406), we finalized case-mix methodology refinements through the Patient-Driven Groupings Model (PDGM) for home health periods of care beginning on or after January 1, 2020. This rule finalizes a policy to align HHVBP Model data submission requirements with any exceptions or extensions granted for purposes of the HH QRP as well as a policy for granting exceptions to the New Measures data reporting requirements during the COVID-19 PHE, as described in the interim final rule with comment period that appeared in the May 8, 2020 Federal Register titled Medicare and Medicaid Programs; Basic Health Program, and Exchanges; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program (85 FR 27553) (May 2020 COVID-19 IFC). MedPAC reiterated its recommendation from its March 2020 report to the Congress to reduce home health payments by 7 percent in CY 2021. Each document posted on the site includes a link to the New research shows that each woman experiences the disparity of gender pay gap in different ways, depending on her position, age, race and education. Section 1895(b)(4)(B) of the Act requires the establishment of appropriate case-mix adjustment factors for significant variation in costs among different units of services. Section 1861(iii)(2) of the Act defines home infusion therapy to include the following items and services: The professional services, including nursing services, furnished in accordance with the plan, training and education (not otherwise paid for as DME), remote monitoring, and other monitoring services for the provision of home infusion therapy and home infusion drugs furnished by a qualified home infusion therapy supplier, which are furnished in the individual's home. We believe that using any available form of telecommunications technology or audio-only technology (i.e., telephone calls), for certain home health services is imperative during the period of the COVID-19 PHE, and did not propose to restrict its usage beyond this timeframe. This temporary payment covers the cost of most of the same items and services, as defined in section 1861(iii)(2)(A) and (B) of the Act, related to the administration of home infusion drugs. 26. The Committee reached consensus on a methodology that resulted in the hospice wage index. Collection of Information Requirements, A. Level of Education: Gaining advanced degrees In a comparison of rates by agency type, RNs in hospital-based home health agencies received the highest in pay with an average hourly rate of $40.10. The amended plan of care requirements at 409.43(a) also state that these services cannot substitute for a home visit ordered as part of the plan of care and cannot be considered a home visit for the purposes of patient eligibility or payment, in accordance with section 1895(e)(1)(A) of the Act. Enrolled nurses (EN) and registered nurses (RN) receive different training. In these cases, a number other than the CBSA number will be needed to identify the appropriate wage index value for claims for home health care provided in CY 2021. The payment amount for each of these three categories is different, though each category has its associated single payment amount. This change in methodology allows for more accurate payment for outlier episodes, accounting for both the number of visits during an episode of care and also the length of the visits provided. End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). For example, dialysis nurses must know how to use a dialysis machine. The report is published in cooperation with the National Association for Home Care & Hospice (NAHC). Based on the more recent data available for this final rule, the current estimate of the 10-year moving average growth of MFP for CY 2021 is 0.3 percentage points. 13-01, announcing revisions to the delineations of MSAs, Micropolitan Statistical Areas, and CBSAs, and guidance on uses of the delineation of these areas. Retaining the three current payment categories maintains consistency with the already established payment methodology and ensures a smooth transition between the temporary transitional payments and the permanent payment system to be implemented beginning in 2021. The definition of home infusion drug excludes a self-administered drug or biological on a self-administered drug exclusion list but the definition of transitional home infusion drug notes that this exclusion shall not apply if a drug described in such clause is identified in clauses (i), (ii), (iii) or (iv) of 1834(u)(7)(C) of the Act. A 30-day period of care can receive only one low comorbidity adjustment regardless of the number of secondary diagnoses reported on the home health claim that fell into one of the individual comorbidity subgroups or one high comorbidity adjustment regardless of the number of comorbidity group interactions, as applicable. The Public Inspection page may also Many commenters specifically suggested including two subcutaneously infused immune-globulins, Xembify and Cutaquig, on Start Printed Page 70339the list of home infusion drugs. Relevant information about this document from Regulations.gov provides additional context. Note: We revised the article to reflect a revised CR 11876. documents in the last year, 24 Is this a good starting rate? Therefore, we proposed to remove the requirement at 484.45(c)(2). Some commenters had specific concerns about HHAs serving patients that reside in counties in the rural add-on high utilization category and such category losing its rural add-on payment in CY 2021. HHC RN per visit rate in FL Published May 7, 2020. Response: We appreciate the commenters' concerns regarding how these changes will affect the delivery of home health care beyond the period of the COVID-19 PHE. Lastly, this rule finalizes the changes to 409.43(a) as set forth in the interim final rule with comment period that appeared in the April 6, 2020 Federal Register titled Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (PHE) (March 2020 COVID-19 IFC), to state that the plan of care must include any provision of remote patient monitoring or other services furnished via a telecommunications system (85 FR 19230). In the CY 2020 HH PPS final rule with comment period (84 FR 60478), we finalized that the payment amounts per category, for an infusion drug administration calendar day under the permanent benefit, be in accordance with the six PFS infusion CPT codes and units for such codes, as described in section 1834(u)(7)(D) of the Act. Payment will be made for each infusion drug administration calendar day in accordance with the definition finalized in the CY 2019 final rule with comment period (83 FR 56583). For more information on the policies we have adopted for the HH QRP, we refer readers to the following: For a detailed discussion of the considerations we historically use for measure selection for the HH QRP quality, resource use, and others measures, we refer readers to the CY 2016 HH PPS final rule (80 FR 68695 through 68696). Section 4410(a) of the Balanced Budget Act of 1997 (Pub. I could do a couple of local, regular visits during the time I spend driving. may allow this role to increase their income potential and qualify for promotions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of less than $7.5 million to $38.5 million in any one year. (1) Enrollment denial by CMS. February 27, 2019. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Home-Infusion-Therapy/Downloads/Home-Infusion-Therapy-Services-Temp-Transitional-Payment-FAQs.pdf. Comment: A few commenters noted that, while helpful for many home health patients, especially those with chronic conditions, CMS should put safeguards in place to ensure that in-person visits are not being replaced by telecommunications technology and that in-person visits remain at adequate levels. We recognize there are areas that will experience a decrease in their wage index. The Medicare National Coverage Determinations Manual, chapter 1, part 4, section 280.14 describes the types of infusion pumps that are covered under the DME benefit. Table 18 represents how HHA revenues are likely to be affected by the policy changes in this final rule for CY 2021. The top employer was hospitals, where 1,713,120 RNs averaged $ 79,460 per year. 24. Achieve double your census volume, at half the cost. Section 1861(iii)(2) of the Act does not define home infusion therapy services to include the pump, home infusion drug, or related services. 18-04 which superseded the April 10, 2018 OMB Bulletin No. We have reviewed this final rule under these criteria of Executive Order 13132, and have determined that it will not impose substantial direct costs on state or local governments. If you are a nurse who has not practiced nursing for 5 to 10 consecutive years, you will need to take a 3-month refresher course called a program. Overtime pay at 1.5 x normal pay rate for hours worked over 40 per week . As discussed previously the most recent OMB Bulletin (No. 21. In some cases there is also added differentials for weekends and holidays +5-10. However, we do appreciate the commenter exploring ways in which these services could be utilized to limit potential exposure to COVID-19. Response: We amended the regulations at parts 409, 424, and 484 to define an NP, a CNS, and a PA as such Start Printed Page 70326qualifications are defined at 410.74 through 410.76. Summary of the Provisions of This Rule, C. Summary of Costs, Transfers, and Benefits, D. Issuance of the Proposed Rulemaking and Correction, II. Through the Local Coverage Determination (LCD) for External Infusion Pumps (L33794), the DME Medicare administrative contractors (MACs) specify the details of which infusion drugs are covered with these pumps. A nurse is paid $30 per visit completed; in week 1 she completes 5 visits and is paid $150 for that week, in week 2 she completes 30 visits and is paid $900 for that week. Section 1834(u)(4) of the Act also allows the Secretary discretion, as appropriate, to consider prior authorization requirements for home infusion therapy services. Under the various Part A prospective payment systems, Medicare payment for the drugs, equipment, supplies, and services are bundled, meaning a single payment is made based on expected costs for clinically-defined episodes of care. Beneficiaries are liable for the Medicare inpatient hospital deductible and no coinsurance for the first 60 days. On the other hand, this does not mean that such dually-enrolled providers and suppliers can use a single Form CMS-855 to encompass both their NSC enrollment and their Part A/B MAC enrollment. These comments are outside the scope of the CY HH PPS 2021 proposed rule but we will consider them, as applicable, in future rulemaking. The national per-visit rates are adjusted by the wage index based on the site of service of the beneficiary. The separate payment for infusion drug Start Printed Page 70331administration in an HOPD and in a physician's office generally includes a base payment amount for the first hour and a payment add-on that is a different amount for each additional hour of administration. In addition, the new iQIES data submission system requires users to include a valid CCN with their iQIES user role request that will allow them to submit their OASIS assessment data to CMS; the new data system no longer supports the use of test or fake CCNs, making it impossible for new HHAs that do not yet have a CCN to submit test data. Alternatively, a lower FDL ratio means that more periods can qualify for outlier payments, but outlier payments per period must then be lower. On September 14, 2018, OMB issued OMB Bulletin No. We stated that the claim should include the length of time, in 15-minute increments, for which professional services were furnished. In response to comments regarding the inclusion of telehealth services as billable visits, we refer readers to section III.F. Section 1895(b)(5) of the Act provides the Secretary with the option to make changes to the payment amount otherwise paid in the case of outliers because of unusual variations in the type or amount of medically necessary care. ++ Is accredited by an organization designated by the Secretary in accordance with section 1834(u)(5) of the Act. They obviously hire per diem to save themselves money in the long run, and thats fine because it can still be very lucrative to the individual nurses. L. 111-148). The summarized comments and responses related to the separation of home infusion therapy services benefit from the HH PPS are found in section V.A.5 . I do live in Mississippi btw. However, OMB occasionally issues minor updates and revisions to statistical areas in the years between the decennial censuses. Comment: Several commenters recommended that CMS reduce or eliminate the 4.36 percent behavior assumption reduction, finalized in the CY 2020 HH PPS final rule with comment period (84 FR 60511-60519)), to the national, standardized 30-day period payment rate for the remainder of CY 2020 and for CY 2021 rate setting. We received two timely public comments on our proposed change to remove the OASIS requirement at 484.45(c)(2). Committee members included representatives of national hospice associations; rural, urban, large, and small hospices; multi-site hospices; consumer groups; and a government representative. After 20 days of SNF care, there is a daily beneficiary cost-sharing amount through day 100 when the beneficiary becomes responsible for all costs for each day after day 100 of the benefit period. On April 10, 2018 OMB issued OMB Bulletin No. Response: Section 1895(b)(5)(A) of the Act allows the Secretary the discretion as to whether or not to have an outlier policy under the HH PPS. In the CY 2015 HH PPS final rule (79 FR 66085 through 66087), we adopted OMB's area delineations using a 1-year transition. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf. While there are information collection requirements associated with the appeals process, we believe they are exempt from the PRA. Rather, the home infusion therapy services benefit covers the professional services associated with drugs that meet the definition of home infusion drugs and are identified in the DME LCD for External Infusion Pumps (L33794). Section 1866(j)(1)(A) of the Act requires the Secretary to establish a process for the enrollment of providers and suppliers in the Medicare program. Section 1895(b)(3)(B)(iv) of the Act provides the Secretary with the authority to implement adjustments to the standard prospective payment amount (or amounts) for subsequent years to eliminate the effect of changes in aggregate payments during a previous year or years that were the result of changes in the coding or classification of different units of services that do not reflect real changes in case-mix. (ii) Certify via the Form CMS-855B that the home infusion therapy supplier meets and will continue to meet the specific requirements and standards for enrollment described in this section and in subpart P of this part. Home health 30-day periods of care can receive a comorbidity adjustment under the following circumstances: Low comorbidity adjustment: There is a reported secondary diagnosis on the home health-specific comorbidity subgroup list that is associated with higher resource use. Aug 4, 2019 This is complex and varies between regions . We apply the wage index budget neutrality factor of 0.9999 to the calculation of the CY 2021 national, standardized 30-day period payment rate. If the home visit includes the provision of home health services in addition to, and separate from, items and services related to home infusion therapy, the HHA would submit both a home health claim and a home infusion therapy services claim, and must separate the time spent performing services covered under the HH PPS from the time spent performing services covered under the home infusion therapy services benefit. We are not discussing these changes in this section because they are inconsequential changes with respect to the home health wage index. 18. Additionally, DME suppliers are required to communicate directly with patients regarding their medications. Managing Experience: If you are a Home Health Nurse L. 115-123) requires the Secretary to implement a new methodology used to determine rural add-on payments for CYs 2019 through 2022. We summarized the comments received in the CY 2020 PFS final rule (84 FR 62568) and the CY 2020 HH PPS final rule with comment period (84 FR 60478), and we stated we would take these comments into consideration as we continue developing future policy through notice-and-comment rulemaking. The Bureau of Labor Statistics (BLS) is the agency that publishes the official measure of private nonfarm business MFP. . In summary, the qualified home infusion therapy supplier is responsible for the reasonable and necessary services related to the administration of the home infusion drug in the individual's home. on hb```f``a`a`` B@1X,0mL.+?jW*fmT Section 1861(iii)(3)(D)(i) of the Act defines a qualified home infusion therapy supplier as a pharmacy, physician, or other provider of services or supplier licensed by the State in which the pharmacy, physician, or provider of services or supplier furnishes items or services. Payment for physician services, including any home infusion care coordination services, are separately paid to the physician under the PFS and are not covered under the home infusion therapy services benefit. $31.04/visit T1030 TT Registered Nurse (RN) Visit provided to more than one recipient in the same setting. Though we did not make any proposals regarding the rural add-on percentages in the CY 2021 HH PPS proposed rule, we did receive some comments as summarized in this section of this final rule. Bulletin No. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. Under the HH PPS, outlier payments are made for episodes whose estimated costs exceed a threshold amount for each Home Health Resource Group (HHRG). (2) CMS may revoke a home infusion therapy supplier's enrollment on any of the following grounds: (i) The supplier does not meet the accreditation requirements as described in paragraph (c)(3) of this section. The mix-and-match, hybrid-type arrangements include visits plus an hourly rate and salary plus an incentive bonus, but those types of agreements can lead to compliance concerns. Thirty days prior to their effective date if circumstances precluded enrollment in advance of providing services to Medicare beneficiaries; or. This includes all such drugs administered to such individual on such day. For a given level of outlier payments, there is a trade-off between the values selected for the FDL ratio and the loss-sharing ratio. 17. Third, section 1866(j) of the Act provides specific authority with respect to the enrollment process for providers and suppliers. Then we applied a wage index budget neutrality factor to ensure budget neutrality for LUPA per-visit payments. To address those geographic areas in which there are no inpatient hospitals, and thus, no hospital wage data on which to base the calculation of the CY 2021 HH PPS wage index, we proposed to continue to use the same methodology discussed in the CY 2007 HH PPS final rule (71 FR 65884) to address those geographic areas in which there are no inpatient hospitals. In accordance with section 1895(b)(3)(B)(v) of the Act and 484.225(c), for an HHA that does not submit home health quality data, as specified by the Secretary, the unadjusted national prospective 30-day period rate is equal to the rate for the previous calendar year increased by the applicable home health payment update, minus 2 percentage points. 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