CMS Issues Proposed Rule on Home Health Care Service Providers

On Tuesday, CMS proposed a rule that would modify eligibility standards for home health service providers and reduce Medicare payments to such providers, The Hill reports.

The proposal is part of CMS' four-year plan under the Affordable Care Act to reduce costs and require more efficiency from providers in home health services (Al-Faruque, The Hill, 7/1).

In April, the HHS Office of Inspector General issued a report stating that CMS made about $2 billion in inappropriate Medicare payments to home health agencies between 2011 and 2012, because physicians routinely failed to properly document the in-person visits required for home-based care referrals (California Healthline, 4/11).

Details of Proposed Rule

Specifically, the agency has proposed reducing Medicare payments by 0.3%, which it says would generate $58 million in savings in 2015 (Dickson, Modern Healthcare, 7/1). In addition, CMS has proposed minimum standards that providers must comply with to demonstrate that they are effective, The Hill reports (The Hill, 7/1).

The proposed rule also would eliminate a requirement that physicians -- who are required under the ACA to have an in-person meeting with patients to certify their need for home health services -- provide a detailed narrative of patients' circumstances to CMS.

The National Association for Home Care & Hospice -- which sued CMS last month over the requirement, arguing that it was outside the scope of the ACA -- said the requirement had resulted in a substantial increase in retroactive denials of providers' claims.

Physicians still would need to document face-to-face meetings to verify patients' eligibility for home health care (Modern Healthcare, 7/1).