Home Health Care Billing: 2017 Changes Rebase the 60-day Episode

The Affordable Care Act directs CMS to apply an adjustment to the national, standardized 60-day episode rate and other applicable amounts to reflect factors such as changes in the number of visits in a home care billing episode, the mix of services in an episode, the level of intensity of services in an episode, the average cost of providing care per episode, and other relevant factors. CMS must phase-in any adjustment over a four-year period, in equal increments, not to exceed 3.5 percent of the amount (or amounts) as of the date of the enactment of the Affordable Care Act (CY 2010).

In this final rule, CMS would complete the final year of the four-year phase-in of the rebasing adjustments to the home health care billing PPS payment rates. As finalized in the CY 2014 final rule, the CY 2017 rebasing adjustment to the national, standardized 60-day payment rate is -$80.95. The overall impact due to the rebasing adjustments is estimated to be a 2.3 percent decrease in HH PPS payments for CY 2017. As noted above and further below, this is offset by the home health billing software update percentage, which would increase overall HH PPS payments in CY 2017 by 2.5 percent.

CMS will implement a 0.97 percent reduction to the national, standardized 60-day episode rate in CY 2017 to account for nominal case-mix growth from 2012 to 2014 (prior to rebasing). CY 2017 will be the second year of the three-year phase-in of the reduction to account for nominal case-mix growth. The -0.97 percent adjustment to the national, standardized 60-day episode payment rate to account for nominal case-mix growth results in an estimated decrease in home health medicare billing PPS payments for CY 2017 of -0.9 percent.