Health Law Daily Home health proposed rule incorporates telehealth, infusion therapy payment benefit
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Friday, June 26, 2020

Home health proposed rule incorporates telehealth, infusion therapy payment benefit

By Kayla R. Bryant, J.D.

The home health proposed rule would allow the continued use of telehealth beyond the COVID-19 public health emergency.

CMS proposed a 2.6 percent increase in payments to home health agencies (HHAs) for 2021. In an advance release of a proposed rule schedule to publish in the Federal Register on June 30, 2020, CMS also proposed implementing enrollment policies for home health infusion suppliers and updates to the home infusion therapy payment rates. The agency also intends to permanently finalize regulations that allow for increased use of telehealth for delivering care to beneficiaries as appropriate.

Payment rates. The home health prospective payment system (HH PPS) percentage update of 2.6 percent reflects the estimated home health market basket update of 3.1 percent, reduced by the multi-factor productivity adjustment (MFP) as required by the Affordable Care Act (ACA) of 0.4 percent and a 0.1 decrease in payments due to reductions in the rural add-on percentages. The proposed per-visit payment rates for each discipline are:

  • Home health aide: $69.53
  • Medical social services: $246.10
  • Occupational therapy: $168.98
  • Physical therapy: $167.83
  • Skilled nursing: $153.54
  • Speech-language pathology: $187.42.

The home health rate is decreased by 2 percentage points for HHAs that fail to submit required quality data. This reduces the payment rates for each discipline to:

  • Home health aide: $68.17
  • Medical social services: $241.31
  • Occupational therapy: $165.69
  • Physical therapy: $164.56
  • Skilled nursing: $150.55
  • Speech-language pathology: $178.87.

Technology. In the first CMS interim final rule with comment period (IFC) (85 FR 19230, April 6, 2020) related to the COVID-19 public health emergency (PHE), plan of care regulations were changed in the interim to require plans of care to include provision of telehealth services. The plan of care was required to describe how the technology will meet patient-specific needs and help achieve the plan of care goals. These services cannot be considered a home visit for the purposes of eligibility and payment and cannot substitute a home visit ordered by the plan of care. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) (P.L. 116-136) also required HHS to consider ways to encourage the use of telehealth in home health services.

CMS proposes to permanently finalize the amendment to 42 C.F.R. §409.43(a) as established in the first IFC. CMS proposes to allow HHAs to report the costs of telehealth as allowable administrative costs. The agency proposes amending §409.46(e) to include remote patient monitoring and other communications or monitoring services consistent with a patient’s plan of care in order to allow HHA’s to plan for the continued inclusion of telecommunications systems, which agencies have obtained at significant costs. The proposed rule emphasizes that an HHA must make an in-person visit to furnish any services that cannot be provided through telehealth, such as wound care.

Home infusion therapy. CMS continues to develop the home infusion therapy services benefit established by the 21st Century Cures Act (Cures Act) (P.L. 114-255), which created a separate Medicare Part B benefit category effective January 1, 2021. The infusion pump and supplies will be covered under the Part B durable medical equipment (DME) benefit, while the therapy benefit includes professional services, monitoring, and training and education. CMS has established various payment categories for infusion services.

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