CMS Issues Final Home Health PPS Rule for 2013
The Centers for Medicare & Medicaid Services (CMS) released its Home Health Prospective Payment System (PPS) final rule for calendar year 2013. The rule will decrease Medicare payments to home health agencies (HHAs) by approximately 0.01% or $10 million. The rule also allows regulatory flexibility regarding therapy reassessments and face-to-face encounter requirements, corrects a G code description (as requested by AOTA), extends certain hospice quality reporting requirements to subsequent years, establishes new survey and certification requirements for HHAs, and provides alternative sanctions if HHAs were out of compliance with Federal requirements
Therapy Revisions
The rule finalized therapy coverage proposals as proposed (see CMS Issues Proposed Home Health PPS Rule for 2013). The revisions to therapy include:
- If a qualified therapist missed a reassessment visit, therapy coverage would resume with the visit during which the qualified therapist completed the late reassessment, not the visit after the therapist completed the late reassessment.
- In cases where multiple therapy disciplines are involved, if the required reassessment visit was missed for any one of the therapy disciplines for which therapy services were being provided, therapy coverage would cease only for that particular therapy discipline.
- In cases where the patient is receiving more than one type of therapy, qualified therapists must complete their reassessment visits during the 11th, 12th, or 13th visit for the required 13th visit reassessment and the 17th, 18th, or 19th visit for the required 19th visit reassessment.
AOTA submitted comments to CMS on the proposed rule on September 4, 2012 (see AOTA Comment Letter). The final rule was published in the Federal Register on November 8, 2012 and is effective January 1, 2013. Please email questions to AOTA’s Regulatory Policy Department at rrpd@aota.org.
CMS Announcement: CMS Finalizes 2013 Medicare Home Health Payment Changes
