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

Year 2012

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.