If the LUPA threshold for the payment group is met under the PDGM, the 30-day period of care will be paid the full 30-day period case-mix adjusted payment amount. In that final rule, we finalized the reduction in up-front payment made in response to a RAP to zero percent for all 30-day periods of care beginning on or after January 1, 2021 (84 FR 60544). This rule adopts the OMB statistical areas and the 5 percent cap on wage index decreases under the statutory discretion afforded to the Secretary under sections 1895(b)(4)(A)(ii) and (b)(4)(C) of the Act. For example, some counties that change OMB designations will have a wage index value that is different than the wage index value associated with the CBSA or rural area they are moving to because of the transition. The amended section 421(a) of the MMA required, for home health services furnished in a rural area (as defined in section 1886(d)(2)(D) of the Act), on or after January 1, 2006, and before January 1, 2007, that the Secretary increase the payment amount otherwise made under section 1895 of the Act for those services by 5 percent. Section IV.A and B. of this final rule discuss the HH QRP and changes to the Conditions of Participation (CoPs) OASIS requirements. Supervise and coordinate home health care staff. We emphasize that our proposed enrollment requirements (for example, including home infusion therapy suppliers within the limited risk screening category rather than the moderate or high risk category) were carefully tailored to balance the need to protect the Trust Funds and beneficiaries from unqualified suppliers with the importance of limiting supplier burden to the extent possible. MedPAC recommended that Congress repeal the existing hospital wage index and instead implement a market-level wage index for use across the inpatient prospective payment system and other prospective payment systems, including certain post-acute care providers. This payment, for home infusion therapy services, is only made if a beneficiary is furnished certain drugs and biologicals administered through an item of covered DME, and payable only to suppliers enrolled in Medicare as pharmacies that provide external infusion pumps and external infusion pump supplies (including the drug). This rule sets forth the case-mix weights under section 1895(b)(4)(A)(i) and (b)(4)(B) of the Act for 30-day periods of care in CY 2021; the CY 2021 fixed-dollar loss ratio (FDL); and the loss-sharing ratio for outlier payments (as required by section 1895(b)(5)(A) of the Act). This section defines home infusion therapy as the items and services described in paragraph (2), furnished by a qualified home infusion therapy supplier which are furnished in the individual's home. 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. Conducts database checks on a pre- and post-enrollment basis to ensure that providers and suppliers continue to meet the enrollment criteria for their provider or supplier type. We have been voted Best of the Best for . 17-01 in which it announced that one Micropolitan Statistical Area, Twin Falls, Idaho, now qualifies as a Metropolitan Statistical Area. The President of the United States communicates information on holidays, commemorations, special observances, trade, and policy through Proclamations. "$bDhKaa,/e2) jc[IoU? Section 1895(b)(1) of the Act requires the Secretary to establish a HH PPS for all costs of home health services paid under Medicare. Collectively, commenters expressed disagreement with the proposal to amend 409.49 to exclude services covered under the home infusion therapy services benefit from the home health benefit. Comment: Several commenters stated that a number of home health agencies and hospices do not intend to enroll as Part B home infusion therapy suppliers. We also established a policy for granting exceptions to the New Measures data reporting requirements under the HHVBP Model during the PHE for COVID-19. A summary of these comments and our responses to those comments are as follows: Comment: Commenters generally supported the adoption of the revised OMB delineations from the September 14, 2018 Bulletin No. And beginning in CY 2022, we will annually update the single payment amount from the prior year for each home infusion therapy payment category by the percent increase in the Consumer Price Index for all urban consumers (CPI-U) for the 12-month period ending with June of the preceding year, reduced by the 10-year moving average of changes in annual economy-wide private nonfarm business multifactor productivity (MFP) as required by section 1834(u)(3) of the Act. In addition, we implemented the establishment of regulatory authority for the oversight of national accrediting organizations (AOs) that accredit home infusion therapy suppliers, and their CMS-approved home infusion therapy accreditation programs. Specifically, the commenter asked if a rural add-on payment would be paid in CY 2021 if an HHA changed from an urban to a rural CBSA and whether the rural add-on payment would no longer be paid if an HHA changed from a rural to an urban CBSA in CY 2021 based on the new OMB delineations. 1302, 1395m, 1395hh, 1395rr, and 1395ddd. We solicited comments in the CY 2020 PFS proposed rule (84 FR 40716) and the CY 2020 HH PPS proposed rule (84 FR 34694), regarding the appropriate form, manner, and frequency that any physician must use to provide notification of the treatment options available to his/her patient for the furnishing of infusion therapy (home or otherwise) under Medicare Part B. As finalized in the CY 2020 HH PPS final rule with comment period, Medicare does not pay for those days of home health services based on the from date on the claim to the date of filing of the RAP. We plan on monitoring home infusion therapy service lengths of visits, both initial and subsequent, in order to evaluate whether the data substantiates this increase or whether we should re-evaluate whether, or how much, to increase the initial visit payment amount. We are not making any changes to the split-percentage payment policy finalized in the CY 2020 HH PPS final rule. Local Coverage Determination (LCD): External Infusion Pumps (L33794). A commenter had concerns Start Printed Page 70321regarding the change in the OMB delineations and how the new CBSA re-designation would affect any rural add-on payments. 8. Therefore, each payment category would reflect variations in infusion drug administration services. Temporary Transitional Payment for Home Infusion Therapy Services for CYs 2019 and 2020. I was just wondering what the normal pay is per visit for home health nurses, so I know what's fair. Home Health Visit Services Fee Schedule 2021 CODE MOD 1 MOD 2 DESCRIPTION OF SERVICE MAXIMUM . Because everything we do, we have to please the government and follow those various state and federal rules.. We do not anticipate a change to Medicare expenditures as a result of this policy. So pay per visit, a lot of times, is convenient for payroll purposes but it does have a lot of unintended consequences.. There are some drugs that are paid for under the transitional benefit but would not be defined as a home infusion drug under the permanent benefit beginning with 2021. We also realize that many home health agencies would have higher area wage index values under the new OMB delineations. For home health periods of care beginning on or after January 1, 2020, Medicare makes payment under the HH PPS on the basis of a national, standardized 30-day period payment rate that is adjusted for the applicable case-mix and wage index in accordance with section 51001 (a) (1) (B) of the BBA of 2018. We received no comments concerning our projected application fee transfers and are therefore finalizing them as proposed. (The National Supplier Clearinghouse (NSC) is the Medicare contractor that processes Form CMS-855S applications. where you can start, Often when we think of nurses the first thought that came to mind was a person in a white uniform who was responsible for helping doctors, but there was more to this profession. Changes to the Conditions of Participation (CoPs) OASIS Requirements, 4. Managing Experience: If you are a Home Health Nurse Response: We appreciate the unanimous support in deleting the OASIS requirement at 484.45(c)(2). For purposes of this estimate, the number of reviewers of this year's rule is equivalent to the number of comments received for the CY 2021 HH PPS proposed rule. A Rule by the Centers for Medicare & Medicaid Services on 11/04/2020. The initial visit percentage increase will still be calculated using the average difference between the PFS amounts for E/M existing patient visits and new patient visits for a given year; however, now only new patient E/M codes 99202 through 99205 will be used in the calculation. Learn more here. 20-01) was published on March 6, 2020 and is available at https://www.whitehouse.gov/wpcontent/uploads/2020/03/Bulletin-20-01.pdf. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of a metropolitan statistical area and has fewer than 100 beds. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. If an HHA does not become accredited and enrolled as a qualified home infusion therapy supplier and is treating a patient receiving a home infusion drug, the HHA must contract with a qualified home infusion therapy supplier to furnish the services related to the home infusion drug. Nurses; Specialties; Students; Trending; . This analysis must conform to the provisions of section 604 of RFA. However, as we discussed in the proposed rule, the purpose of the proposed transition policy is to help mitigate the significant negative impacts of certain wage index changes. Specializes in NICU, PICU, Transport, L&D, Hospice. If the rates were set using the proposed CY 2021 PFS rates the budget neutrality factor would be 0.9951. Weeks of care are then transformed into estimated visits of care, where we assumed 2 visits for the initial week of care, with 1 visit per week for all subsequent weeks for categories 1 and 3, and we assumed 1 visit per month, or 12 visits per year, for category 2. Many commenters supported the amendment to 409.43(a), allowing the use of telecommunications technology to be included as part of the home health plan of care during both the COVID-19 PHE, as well as beyond this time period, under the Medicare home health benefit. When you are a registered nurse You can become a senior registered nurse and take on greater responsibilities. Agencies have [certainly] been penalized for not paying properly [with these models]., C3 Advisors, Home Health Solutions LLC, NAHC. Due to the way that the transition wage index is calculated, some Core Based Statistical Areas (CBSAs) and statewide rural areas will have more than one wage index value associated with that CBSA or rural area. The other HHVBP measures are calculated using OASIS data, which are still required to be reported during the PHE; however, we have given providers additional time to submit OASIS data (https://www.cms.gov/files/document/covid-home-health-agencies.pdf); claims-based data extracted from Medicare fee-for-service (FFS) claims; and New Measure data. Additionally, section 1895(b)(3)(D) of the Act requires the Secretary to analyze data for CYs 2020 through 2026, after implementation of the 30-day unit of payment and new case-mix adjustment methodology under the PDGM, to annually determine the impact of the differences between assumed and actual behavior changes on estimated aggregate expenditures and, at a time and manner determined appropriate by the Secretary, make permanent and temporary adjustments to the 30-day payment amounts. The fifth column shows the payment effects of the CY 2021 rural add-on payment provision in statute. In order to make the application of the GAF budget neutral we will apply a budget-neutrality factor. As set out at section 1834(u)(7)(C) of the Act, identified HCPCS codes for transitional home infusion drugs are assigned to three payment categories, as identified by their corresponding HCPCS codes, for which a single amount will be paid for home infusion therapy services furnished on each infusion drug administration calendar day. However, we noted that, under section 1862(a)(1)(A) of the Act, no payment can be made for Medicare services under Part B that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, unless explicitly authorized by statutes. Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services, section 50.2Determining Self-Administration of Drug or Biological. Section 409.46 is amended by revising paragraph (e) to read as follows: (e) Telecommunications technology. As stated in the CY 2008 HH PPS final rule, we stated that the average visit lengths in these initial LUPAs are 16 to 18 percent higher than the average visit lengths in initial non-LUPA episodes (72 FR 49848). We are seeking candidates who are compassionate, caring, motivated and have a true servant's heart. The sixth column shows the payment effects of the CY 2021 home health payment update percentage and the last column shows the combined effects of all the policies finalized in this rule. Follow-up services to the beneficiary and/or caregiver(s), must be consistent with the type(s) of equipment, item(s) and service(s) provided, and include recommendations from the prescribing physician or healthcare team member(s). For reasons identical to those behind 424.68(c), we proposed several provisions in new 424.68(e). While CMS and other stakeholders have explored potential alternatives to using OMB's statistical area definitions, no consensus has been achieved regarding how best to implement a replacement system. Section 504 of the Rehabilitation Act, section 1557 of the Patient Protection and Affordable Care Act (ACA), and the Americans with Disabilities Act (ADA) protect qualified individuals with disabilities from discrimination on the basis of disability in the provision of benefits and services. A more detailed description as to how these response categories were established can be found in the technical report, Overview of the Home Health Groupings Model, which is posted on our HHA web page. The nurse should coordinate with the pharmacy. [12] A partial payment adjustment as set forth in 484.205(d)(2) and 484.235. Section 1834(u)(1)(A)(ii) of the Act requires that the payment amount take into account variation in utilization of nursing services by therapy type. L. 96-354), section 1102(b) of the Act, section 202 of the Unfunded Mandates Reform Act of 1995 (March 22, 1995; Pub. The CY 2021 final PFS amounts were not available at the time of rulemaking; however any impact to the CY 2021 home infusion therapy payment amounts are be attributed to changes in the PFS amounts for 2021. This information may be maintained electronically. of this final rule, by the appropriate rural add-on percentage prior to applying any case-mix and wage index adjustments. Under the new OMB delineations (based upon the 2010 decennial Census data), a total of 34 counties (and county equivalents) that are currently considered urban are considered rural beginning in CY 2021. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. Enrolled nurses (EN) and registered nurses (RN) receive different training. (4) Is enrolled in Medicare as a home infusion therapy supplier consistent with the provisions of this section and subpart P of this part. Given these concerns, in the CY 2017 HH PPS final rule (81 FR 76702), we finalized changes to the methodology used to calculate outlier payments, using a cost-per-unit approach rather than a cost-per-visit approach. Traditional fee-for-service (FFS) Medicare provides coverage for infusion drugs, equipment, supplies, and administration services. When the home health agency furnishing home health services is also the qualified home infusion therapy supplier furnishing home infusion therapy services, and a home visit is exclusively for the purpose of furnishing items and services related to Start Printed Page 70336the administration of the home infusion drug, the home health agency would submit a home infusion therapy services claim under the home infusion therapy services benefit. 20-01 in any changes that would be adopted in future rulemaking. We applied a blended wage index for 1 year (CY 2015) for all geographic areas that would consist of a 50/50 blend of the wage index values using OMB's old area delineations and the wage index values using OMB's new area delineations. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. On the other hand, if there is overtime and a clinician racks up a lot of hours on their timesheet and continues to work that could end up being harmfully expensive for the agency. Section 1895(b)(3)(D)(i) of the Act requires the Secretary to annually determine the impact of differences between assumed behavior changes as described in section 1895(b)(3)(A)(iv) of the Act, and actual behavior changes on estimated aggregate expenditures under the HH PPS with respect to years beginning with 2020 and ending with 2026. Section 50208(a) of the BBA of 2018 amended section 421(a) of the MMA to extend the rural add-on by providing an increase of 3 percent of the payment amount otherwise made under section 1895 of the Act for home health services provided in a rural area (as defined in section 1886(d)(2)(D) of the Act), for episodes and visits ending before January 1, 2019. They are paying 65/60 for SOC/ROC per visit. We also note that our previously mentioned proposals to revise 424.520(d) and 424.521(a) would permit home infusion therapy suppliers to back bill for certain services furnished prior to the date on which the MAC approved the supplier's enrollment application. The documents posted on this site are XML renditions of published Federal Based upon the 2010 Decennial Census data, a number of urban counties have switched status and have joined or became Micropolitan Areas, and some counties that once were part of a Micropolitan Area, have become urban. 18-04, which superseded the April 10, 2018 OMB Bulletin No. of this final rule discusses final policies on reporting under the HHVBP Model during the COVID-19 PHE. 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. However, for rural Puerto Rico, we do not apply this methodology due to the distinct economic circumstances that exist there (for example, due to the close proximity to one another of almost all of Puerto Rico's various urban and non-urban areas, this methodology would produce a wage index for rural Puerto Rico that is higher than that in half of its urban areas). Pay structures also need to be compliant with applicable wage-and-hour laws. 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. Hall, Render, Killian, Health & Lyman is one of the largest health care law firms in the country. 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. Finally, a few commenters recommended that the home health wage index utilize geographic reclassification and a rural floor like the hospital wage index. All Rights Reserved (or such other date of publication of CPT). Federal Register provide legal notice to the public and judicial notice We also noted our belief that any costs associated with home infusion therapy supplier appeals would, in any event, be de minimis; this is because we would anticipate, based on past experience, there would be comparatively few denials and revocations of home infusion therapy supplier enrollments. While cardiology nurses must be meticulous in using an electrocardiogram (ECG) machine. 1302 and 1395hh. Finally, with the influx of education and new technologies Nurses must keep abreast of current health trends. Commenters agreed that as a result of the implementation of the internet Quality Improvement & Evaluation System (iQIES), they support removing the requirement at 484.45(c)(2) in accordance with improved online connectivity for reporting OASIS data. We inadvertently did not update 409.64(a)(2)(ii), 410.170(b), and 484.110 in the regulations when implementing the requirements set forth in the CARES Act in the May 2020 COVID-19 IFC regarding the allowed practitioners who can certify and establish home health services. The average Home Health Registered Nurse salary in the United States is $74,621 as of , but the salary range typically falls between $68,997 and $80,996. Bulletin No. Payment for an infusion drug administration calendar day is a bundled payment, which reflects not only the visit itself, but any necessary follow-up work (which could include visits for venipuncture), or care coordination provided by the qualified home infusion therapy supplier. Response: CMS thanks the commenters for their comments on the market basket percentage and appreciates their concerns regarding additional costs, such as PPE, due to the COVID-19 PHE. One commenter expressed concern with the number of eligible entities that intend to enroll as home infusion therapy suppliers and whether there will be sufficient suppliers enrolled, particularly in rural areas. Full-time + 2. The Affordable Care Act made additional changes to the HH PPS. Unlike previous rural add-ons, which were applied to all rural areas uniformly, the extension provided varying add-on amounts depending on the rural county (or equivalent area) classification by classifying each rural county (or equivalent area) into one of three distinct categories: (1) Rural counties and equivalent areas in the highest quartile of all counties and equivalent areas based on the number of Medicare home health episodes furnished per 100 individuals who are entitled to, or enrolled for, benefits under Part A of Medicare or enrolled for benefits under Part B of Medicare only, but not enrolled in a Medicare Advantage plan under Part C of Medicare (the High utilization category); (2) rural counties and equivalent areas with a population density of 6 individuals or fewer per square mile of land area and are not included in the High utilization category (the Low population density category); and (3) rural counties and equivalent areas not in either the High utilization or Low population density categories (the All other category). It is possible that not all commenters reviewed this year's rule in detail, and it is also possible that some reviewers chose not to comment on the proposed rule. March 30, 2023 Washington, D.C. While doctors spend only a short time with patients, nurses tend to devote entire shifts to them. 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. 03/01/2023, 828 An outlier payment as set forth in 484.205(d)(3) and 484.240. Some nurses are trained to care for patients on the ward. Under 424.514, prospective and revalidating institutional providers that are submitting an enrollment application generally must pay the applicable application fee. We recognize that collaboration between the ordering physician and the DME supplier furnishing the home infusion drug is imperative in providing safe and effective home infusion. are not part of the published document itself. June 2020. https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Opioid-epidemic-roadmap.pdf. Additionally, 1895(b)(3)(D)(iii) of the Act requires the Secretary, at a time and in a manner determined appropriate, through notice and comment rulemaking, to provide for one or more temporary increases or decreases, based on retrospective behavior, to the payment amount for a unit of home health services for applicable years, on a prospective basis, to offset for such increases or decreases in estimated aggregate expenditures, as determined under section 1895(b)(3)(D)(i) of the Act. Divide the case-mix adjusted amount into a labor (76.1 percent) and a non-labor portion (23.9 percent). Each 30-day period of care is classified into one of two admission source categoriescommunity or institutionaldepending on what healthcare setting was utilized in the 14 days prior to home health. A number of commenters expressed support for CMS's waivers related to quality reporting for quarters affected by the COVID-19 PHE. Response: We thank the commenters for their comments. 3. Payment to a qualified home infusion therapy supplier is for an infusion drug administration calendar day in the individual's home, which, in accordance with section 1834(u)(7)(E) of the Act, refers to payment only for the date on which professional services were furnished to administer such drugs Start Printed Page 70335to such individual. (ii) Any of the applicable denial reasons in 424.530. Section 1895(b)(4) of the Act governs the payment computation. Therefore, we find that undertaking further notice and comment procedures to incorporate these changes into this final rule is unnecessary and contrary to the public interest. Additionally, we believe that the 5 percent cap on wage index decreases is an adequate safeguard against any significant payment reductions and do not believe that capping wage index decreases at 3 percent instead of 5 percent is appropriate. Table 13 provides the list of J-codes associated with the infusion drugs that fall within each of the payment categories. Estimates of national spending totals are derived from a function of beneficiary counts, weeks of care, and estimated visits of care by home infusion therapy drug payment category, which were compiled from CY 2019 utilization data. We note that the first quarter 2020 forecast used for the proposed home health market basket percentage increase was developed prior to the economic impacts of the COVID-19 PHE. Therefore, the Secretary has determined that this final rule will not have a significant economic impact on the operations of small rural hospitals. 3. Local Coverage Determination (LCD): External Infusion Pumps (L33794). Extending the 5-day completion requirement for the comprehensive assessment to 30 days; Waiving the 30-day OASIS submission requirement (though HHAs must submit OASIS data prior to submitting their final claim in order to receive Medicare payment); Changing the home health regulations to include physician assistants, nurse practitioners, and clinical nurse specialists as individuals who can certify the need for home health services and order services. All other 30-day periods of care would be designated as community admissions. These per 15-minute unit rates are used to calculate the estimated cost of an episode to determine whether the claim will receive an outlier payment and the Start Printed Page 70322amount of payment for an episode of care. SPONSORED BY: The payment category may be determined by the DME MAC for any subsequent home infusion drug additions to the DME LCD for External Infusion Pumps (L33794)[22] Therefore, in response to comments as to the frequency of the assumed behaviors during the first year of the transition to a new unit of payment and case-mix adjustment methodology, we finalized to apply the three behavior change assumptions, as finalized in the CY 2019 HH PPS final rule with comment period, to only half of the 30-day periods for purposes of calculating the CY 2020 30-day payment rate. The authority citation for part 410 continues to read as follows: Authority: Final Decision: We are finalizing our proposal to adopt the revised OMB delineations from the September 14, 2018 OMB Bulletin 18-04 and apply a 1-year 5 percent cap on wage index decreases as proposed, meaning the counties impacted will receive a 5 percent cap on any decrease in a geographic area's wage index value from the wage index value from the prior calendar year for CY 2021 effective January 1, 2021. Centers for Medicare & Medicaid Services on 11/04/2020 NICU, PICU, Transport, L &,..., supplies, and 1395ddd for Medicare & Medicaid Services on 11/04/2020 rule discuss HH! Changes to the HH PPS final rule discuss the HH PPS final rule final. The new OMB delineations OMB delineations published on March 6, 2020 and is available at:! 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