Entry By: Eileen Bach, PT, M.Ed, DPT
CMS has released the final PPS rules for home health care. Link and brief summary posted here.
The 2012 CMS Home Care PPS rules can be found at: www.ofr.gov/OFRUpload/OFRData/2011-28416_PI.pdf.
Medicare Program; Home Health Prospective Payment System Rate Update for Calendar
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule.
SUMMARY: This final rule sets forth updates to the home health prospective payment system
(HH PPS) rates, including: the national standardized 60-day episode rates; the national per-visit
rates; and the low utilization payment amount (LUPA) under the Medicare PPS for home health
agencies effective January 1, 2012. This rule applies a 1.4 percent update factor to the episode
rates, which reflects a 1 percent reduction applied to the 2.4 percent market basket update factor,
as mandated by the Affordable Care Act. This rule also updates the wage index used under the
HH PPS, and further reduces home health payments to account for continued nominal growth in
case-mix which is unrelated to changes in patient health status. This rule removes two
hypertension codes from the HH PPS case-mix system, thereby requiring recalibration of the
case-mix weights. In addition, the rule implements two structural changes designed to decrease
incentives to upcode and provide unneeded therapy services. Finally, this rule incorporates
additional flexibility regarding face-to-face encounters with providers related to home health
EFFECTIVE DATE: These regulations are effective on January 1, 2012.