CMS Proposes Payment Changes in 2011 To Medicare Home Health Services

Last week, the Centers for Medicare & Medicaid Services (CMS) announced a number of changes to Medicare home health payments for 2011 that reflect implementation of the Affordable Care Act (ACA).  The proposed changes represent a 4.75 percent decrease in Medicare payments to home health agencies (HHAs) for calendar year 2011 which is approximately a $900 million net decrease when compared to 2010. 

The changes include the combined effects of a market basket update, a wage index update, reductions to the home health prospective payment system (HH PPS) rates to account for increases in aggregate case-mix that are unrelated to underlying changes in patients’ health status, and  other provisions mandated of the ACA of 2010.  The ACA of 2010 outlines additional payment changes for 2011 and 2012.


The proposed rule also offers an approach to implement an ACA provision, which mandates that, prior to certifying a patient’s eligibility for the Medicare home health benefit, the physician must document that the physician or a non-physician practitioner has had a face-to-face encounter with the patient.  “Patient care and access are ultimately what CMS is looking to protect, while working aggressively to prevent fraud. The proposed rule establishes timeframes for these encounters and documentation requirements associated with the provision,” said Jonathan Blum, director of the Center for Medicare and deputy administrator for CMS.