{"id":26071,"date":"2019-10-31T12:20:23","date_gmt":"2019-10-31T12:20:23","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=26071"},"modified":"2019-10-31T12:20:23","modified_gmt":"2019-10-31T12:20:23","slug":"cms-lowers-pdgms-behavioral-adjustment-finalizes-rap-elimination-plan","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/cms-lowers-pdgms-behavioral-adjustment-finalizes-rap-elimination-plan\/","title":{"rendered":"CMS Lowers PDGM\u2019s Behavioral Adjustment, Finalizes RAP Elimination Plan"},"content":{"rendered":"\n

The Centers for Medicare & Medicaid Services (CMS) on Thursday finalized the Patient-Driven Groupings Model (PDGM) for 2020, in addition to its plan to phase out home health pre-payments and introduce a new home infusion therapy benefit.
<\/p>\n\n\n\n

But perhaps the biggest news for U.S. home health providers is a major update to PDGM\u2019s widely opposed and controversial behavioral adjustment.<\/p>\n\n\n\n

Broadly, the assumption-based behavioral adjustment is built on CMS\u2019s belief that agencies will automatically change their coding and visit behavior in order to maximize reimbursement under the looming payment overhaul.
<\/p>\n\n\n\n

In its proposed payment rule dropped in July, the PDGM behavioral adjustment stood at 8.01%. In Thursday\u2019s final rule for calendar year 2020, that adjustment decreased to 4.36%, a figure that\u2019s likely still higher than the industry would like \u2014 but a significant drop nonetheless.
<\/p>\n\n\n\n

\u201cBased on the comments received and reconsideration as to frequency of the assumed behaviors during the first year of the transition to a new unit of payment and case-mix adjustment methodology, we are finalizing a -4.36% behavior change assumptions adjustment in order to calculate the 30-day payment rate in a budget-neutral manner for CY 2020,\u201d CMS wrote in its final rule.<\/p>\n\n\n\n

National Association for Home Care & Hospice (NAHC) President William A. Dombi said his organization was \u201cgreatly heartened\u201d by the move and that it represents a \u201cmuch more realistic view\u201d of the PDGM-transition process. <\/p>\n\n\n\n

NAHC didn\u2019t back off its opposition to assumption-based behavioral adjustments all together, though.<\/p>\n\n\n\n

\u201cThe Bipartisan Budget Act of 2018 requires that the home health payment model reform be budget neutral,\u201d Dombi said in a statement to Home Health Care News. \u201cWhile it permits behavioral adjustment to payment rates, NAHC believes that assumption-based rate calculation should not occur because of the high risks of error and the creation of an incentive to change behavior solely to maintain Medicare revenues. Instead, NAHC supports adjustments only after actual behavioral changes have occurred.\u201d<\/p>\n\n\n\n

CMS\u2019s move to somewhat lessen its assumption-based adjustment isn\u2019t just in response to industry feedback: It\u2019s also due to Congressional attention. Dozens of U.S. senators and more than 100 House lawmakers have signed on to legislation targeting PDGM\u2019s behavioral adjustment.<\/p>\n\n\n\n

\u201cWhile the PDGM payment model reforms include sensible changes, the behavioral adjustment remains a concern, albeit to a reduced level,\u201d Dombi said. \u201cThere is bipartisan, bicameral legislation pending, S. 433<\/a> and H.R. 2573<\/a>, that can help resolve these concerns fully.\u201d<\/p>\n\n\n\n

Overall, CMS\u2019s final rule for 2020 increases Medicare payments by an estimated 1.3% \u2014 or about $250 million. The increase reflects a 1.5% update required by the Bipartisan Budget Act of 2018, plus a mandated 0.2% decrease to rural add-on payments.
<\/p>\n\n\n\n

While the behavioral adjustment has risen to priority No. 1 for home health providers, CMS\u2019s proposed plan to phase out pre-payments \u2014 or Requests for Anticipated Payments (RAPs) \u2014 had also been a point of focus.<\/p>\n\n\n\n

CMS is officially moving forward with its plan, which some industry experts say will create insurmountable cash-flow problems<\/a> for small and mid-sized providers. Currently, RAPs provide up to 60% of an episode\u2019s anticipated payment at the beginning of care.
<\/p>\n\n\n\n

CMS will begin phasing out pre-payment for home health services over the next year and eliminate them entirely in 2021.<\/p>\n\n\n\n

The agency is killing the RAP, it says, largely due to ongoing fraud concerns.
<\/p>\n\n\n\n

\u201cCMS has seen a marked increase in \u2026 fraud schemes perpetrated by existing [agencies] that receive significant upfront payments, then never submit final claims and close for business, making Medicare recoupment efforts impossible,\u201d agency officials wrote. \u201cCMS believes that eliminating RAP payments over the next two years would serve to mitigate potential fraud schemes while minimally impacting [home health agencies] due to implementation of the PDGM, which increases the frequency of payments for services to [agencies].\u201d<\/p>\n\n\n\n

Instead of a RAP, CMS is finalizing a requirement for a one-time submission of a Notice of Admission (NOA) beginning in 2022. Home health agencies will be required to submit an NOA within give calendar days of the home health start of care \u2014 or be subject to a financial penalty for each late day<\/a>.<\/p>\n\n\n\n

In addition to all those changes, CMS is also finalizing its plan allowing therapist assistants \u2014 rather than only therapists \u2014 to perform maintenance therapy under the Medicare home health benefit, in accordance with individual state practice requirements.<\/p>\n\n\n\n

Broadly, the change allows therapist assistants to use all of the skills under their license and gives home health agencies more flexibility when it comes to maintenance therapy, which some see as under-utilized, according to CMS.<\/p>\n\n\n\n

While CMS is bullish on the change, some industry leaders see it as too little too late<\/a>.<\/p>\n\n\n\n

\u201cThe potential issue is that maintenance therapy visits tend to occur at a lower frequency,\u201d Anthony D\u2019Alonzo, director of clinical strategy and innovation for Bayada Home Health Care, told HHCN in July<\/a>. \u201cAnd CMS isn\u2019t easing up on the [therapy] reassessment rule, which requires PTs, OTs or speech therapists to reassess the patient every 30 days.\u201d
<\/p>\n\n\n\n

Despite the change, therapist assistants still won\u2019t be able to make changes to a patient\u2019s plan of care.<\/p>\n\n\n\n

Home infusion therapy hasn\u2019t been an area of focus for many home health providers, but that may change moving forward thanks to CMS\u2019s final payment rule for 2020.<\/p>\n\n\n\n

Specifically, Thursday\u2019s final rule provides a permanent home infusion therapy benefit to be implemented beginning in 2021, as required by the 21st Century Cures Act. Home infusion therapy is the administration of certain types of medication, through durable medical equipment (DME) pumps, in the patient\u2019s home.<\/p>\n\n\n\n

Apart from advocacy organizations, home health technology partners have also started to weigh in on Thursday\u2019s final rule. The list includes Texas-based software and technology company Axxess. <\/p>\n\n\n\n

\u201cAfter a year-long industry-advocacy drumbeat, we are encouraged that CMS listened \u2026 and reduced the onerous behavioral adjustment,\u201d Deborah Hoyt, senior vice president of public policy for Axxess, told HHCN in an email. \u201cWhile this impact was tempered, several of the other elements in the rule remain quite concerning to home health providers.\u201d<\/p>\n\n\n\n

Axxess will continue to work with home health stakeholders and members of Congress in the coming months to further refine PDGM, Hoyt said.<\/p>\n","protected":false},"excerpt":{"rendered":"

The Centers for Medicare & Medicaid Services (CMS) on Thursday finalized the Patient-Driven Groupings Model 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