We note that in the CY 2017 HH PPS final rule (81 FR 76724), we stated that we did not plan to re-estimate the average minutes per visit by discipline every year. 42 U.S.C. However, we do not yet have the claims and cost report data to conduct the analysis needed for a possible add-on payment to account for any increased costs for PPE. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf. We also received comments on our proposal in the CY 2021 HH PPS proposed rule to amend the language at 409.46(e), allowing a broader use of telecommunications technology to be reported as an allowable administrative cost on the home health agency cost report. For purposes of this section, a home infusion therapy supplier means a supplier of home infusion therapy that meets all of the following requirements: (1) Furnishes infusion therapy to individuals with acute or chronic conditions requiring administration of home infusion drugs. Additionally, a few commenters stated that CMS should permit telecommunication technologies to include audio only (telephonic) technology beyond the period of the COVID-19 PHE. For example, some nurses prefer to focus on dialysis. The purpose of this policy is to ensure that the applicable MAC can: (1) Verify the provider's or supplier's compliance with the state's requirements; and (2) make accurate payments. With regard to payment under traditional Medicare, most home infusion drugs are generally covered under Part B or Part D. Certain infusion pumps, supplies (including home infusion drugs and the services required to furnish the drug, (that is, preparation and dispensing), and nursing are covered in some circumstances through the Part B durable medical equipment (DME) benefit, the Medicare home health benefit, or some combination of these benefits. Payment category 3 includes intravenous chemotherapy infusions, including certain chemotherapy drugs and biologicals. We will consider potential options for collecting data regarding the use of telecommunications technology on home health claims. Some examples of such possible events are newly-legislated general Medicare program funding changes made by the Congress, or changes specifically related to HHAs. Some states and hospital systems may require hourly rates. The difference in an hourly rate in home health, however, is that it relies on an honor system of sorts . While most of the comments were out of scope of the proposed rule because we did not propose to make any changes, we did receive a few technical comments regarding the implementation of the finalized policy, which are summarized in this section of this final rule. The authority citation for part 484 continues to read as follows: Start Printed Page 70356 LEARN MORE. We proposed to continue this practice for CY 2021, as we continue to believe that, in the absence of home health-specific wage data that accounts for area differences, using inpatient hospital wage data is appropriate and reasonable for the HH PPS. These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright 2002, 2004 American Dental Association (ADA). However, CMS will continue to monitor patient access to home health services and the costs associated with providing home health care in rural versus urban areas. But if providers are not cognizant of the fourth aspect labor law compliance the other three may not end up mattering at all. Similar instability may result from the proposed wage policies herein, in particular for home health agencies that would be negatively impacted by the proposed adoption of the updates to the OMB delineations. We believe it is important for the home health wage index to use the latest OMB delineations available in order to maintain a more accurate and up-to-date payment system that reflects the reality of population shifts and labor market conditions. However, in future years under the PDGM, we would apply a case-mix budget neutrality factor with the annual payment update in order to account for the change between the previous year's PDGM case-mix weights and the new recalibrated PDGM case-mix weights. 18-03. 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. These services may require some degree of care coordination or monitoring outside of an infusion drug administration calendar day; payment for these services is built into the bundled payment for an infusion drug administration calendar day. Therefore, we have not developed burden estimates. Home Health Care News Under the Paperwork Reduction Act of 1995, we are required to provide 30-day notice in the Federal Register and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. Response: We thank the commenters for their support. In the CY 2021 HH PPS proposed rule (85 FR 39424), we reminded stakeholders of the policies finalized in the CY 2020 HH PPS final rule with comment (84 FR 60544) with regards to the submission of Requests for Anticipated Payment (RAPs) for CY 2021 and the implementation of a new one-time Notice of Admission (NOA) process starting in CY 2022. If you do You can choose from two paths: You can choose to become a registered nurse immediately. We may adjust a 30-day case-mix and wage-adjusted payment based on the information submitted on the claim to reflect the following: Section 1895(b)(3)(D)(i) of the Act, as added by section 51001(a)(2)(B) of the BBA of 2018, requires us to analyze data for CYs 2020 through 2026, after implementation of the 30-day unit of payment and new PDGM case-mix adjustment methodology, to annually determine the impact of the differences between assumed behavior changes and actual behavior changes on estimated aggregate expenditures. Dietary changes should also be coordinated with the Food and Nutrition Department. Bookmark | These commenters stated that the short and long-term effects are not yet fully known and therefore, there should be no changes to the payment system for CY 2021. The accuracy of our estimate of the information collection burden. Comment: A commenter recommended that CMS consider applying a PHE policy that was established for skilled nursing facilities to the Part A home health benefit, which would allow services provided on the premises, though not necessarily in the same room as the patient, to be considered in-person services. On a basic level, a pay structure should reward outcomes and efficiency rather than visit volume. An early career Home Health Nurse with 1-4 years of experience earns an average total compensation of $29.66 based on 3,904 salaries. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". hVYo8+|LWAm It also mandated implementation of a new methodology for applying those payments. For general information about home infusion payment, send your inquiry via email to: HomeInfusionPolicy@cms.hhs.gov. Any requests regarding additions to the DME LCD for External Infusion Pumps must be made to the DME MACs. Section 50208 of the BBA of 2018 (Pub. Therefore, they used a fake or test CCN in order to transmit test data to the Quality Improvement & Evaluation System Assessment Submission & Processing (QIES ASAP) System or CMS OASIS contractor. Section 1861(iii)(2) of the Act does not define home infusion therapy services to include the pump, home infusion drug, or related services. Section 1895(b)(3)(B)(v) of the Act requires that the home health payment update percentage be decreased by 2.0 percentage points for those HHAs that do not submit quality data as required by the Secretary. In section III.A of this rule, we set the LUPA thresholds and the case-mix weights for CY 2021 equal to the CY 2020 LUPA thresholds and case-mix weights established for the first year of the Patient-Driven Groupings Model (PDGM). Furthermore, as we noted in the CY 2019 HH PPS proposed rule, we consider the home infusion benefit principally to be a separate payment in addition to the existing payment made under the DME benefit, thus explicitly and separately paying for the home infusion therapy services (83 FR 32466). The amended plan of care requirements at 409.43(a) also state that these services cannot substitute for a home visit ordered as part of the plan of care and cannot be considered a home visit for the purposes of patient eligibility or payment, in accordance with section 1895(e)(1)(A) of the Act. Another commenter noted support for the continued inclusion of the Influenza Immunization Received for the Current Flu Season quality measure and suggested the addition of the new composite adult immunizations measure being tested by the National Committee on Quality Assurance. A detailed description of how we rebased the HHA market basket is available in the CY 2019 HH PPS final rule with comment period (83 FR 56425 through 56436). For the same reason, we also established a policy for granting exceptions to New Measure reporting requirements for HHAs participating in the HHVBP Model during the COVID-19 PHE. and consult a doctor if there is any reason for concern. Therefore, the Secretary has determined that this HH PPS final rule would not have a significant economic impact on a substantial number of small entities. A few commenters noted that the decision to provide services via telecommunications technology should be based on the individual's needs as identified during the comprehensive assessment, making the proposal to incorporate these services into the plan of care essential. A 30-day period of care can have a low comorbidity adjustment or a high comorbidity adjustment, but not both. The specific OASIS items that are used for the functional impairment level are found in Table 7 in the CY 2020 HH PPS final rule with comment period (84 FR 60490). This Agreement will terminate upon notice if you violate its terms. Is this useful? [FR Doc. This section discusses our proposed burden estimates for the enrollment of home infusion therapy suppliers as well as the PRA exemption we are claiming for the appeals process. In accordance with section 1834(u)(1)(A)(i) of the Act, the Secretary is required to implement a payment system under which a single payment is made to a qualified home infusion therapy supplier for items and services furnished by a qualified home infusion therapy supplier in coordination with the furnishing of home infusion drugs. Payment for Home Infusion Therapy Services, 6. Comment: Several commenters inquired about CMS's utilization of data from the last performance year of the Model (CY 2020). (1) The HHA must be acting upon a plan of care that meets the requirements of this section for HHA services to be covered. Both amounts cover one academic year. has no substantive legal effect. The overarching purpose of the enrollment process is to help confirm that providers and suppliers seeking to bill Medicare for services and items furnished to Medicare beneficiaries meet all federal and state requirements to do so. $31.04/visit T1030 TT Registered Nurse (RN) Visit provided to more than one recipient in the same setting. We acknowledged that the exceptions to the HH QRP reporting requirements, as well as the modified submission deadlines for OASIS data and our exceptions for the New Measures reporting requirements, may impact the calculation of performance under the HHVBP Model for PY 2020. Hourly rates are the easiest to set up from a payroll perspective on the administrative end. The clinical grouping is based on the principal diagnosis reported on home health claims. A summary of the comments and our responses are as follows: Comment: Commenters overwhelmingly supported CMS' acknowledgment that telecommunications technology has a place in home health for public health emergencies and beyond. They are paying 65/60 for SOC/ROC per visit. Specifically, certifications and re-certifications continue on a 60-day basis and the comprehensive assessment must still be completed within 5 days of the start of care date and completed no less frequently than during the last 5 days of every 60 days beginning with the start of care date, as currently required by 484.55, Condition of participation: Comprehensive assessment of patients.. It is important to note that the list of home infusion drugs is maintained by the DME MACs and the drugs or their respective payment categories do not need to be updated through rulemaking every time a new drug is added to the DME LCD for External Infusion Pumps (L33794). Home Health Visit Services Fee Schedule 2021 CODE MOD 1 MOD 2 DESCRIPTION OF SERVICE MAXIMUM . documents in the last year, 662 In new 424.68(d)(1)(i) and (ii), respectively, we proposed that CMS may deny a home infusion therapy supplier's enrollment application on either of the following grounds: In new 424.68(d)(2), we proposed that a home infusion therapy supplier may appeal the denial of its enrollment application under 42 CFR part 498. ++ Is enrolled in Medicare as a home infusion therapy supplier consistent with the provisions of 424.68 and part 424, subpart P. In paragraph (b), we proposed that for a supplier to receive Medicare payment for the provision of home infusion therapy supplier services, the supplier must: (1) Qualify as a home infusion therapy supplier (as defined in 424.68); and (2) be in compliance with all applicable provisions of 424.68 and part 424, subpart P. 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