The new CBSA (46300) comprises the principal city of Twin Falls, Idaho in Jerome County, Idaho and Twin Falls County, Idaho. And finally, section 51001(a)(3) of the BBA of 2018 amends section 1895(b)(4)(B) of the Act by adding a new clause (ii) to require the Secretary to eliminate the use of therapy thresholds in the case-mix system for CY 2020 and subsequent years. We are also finalizing without modification the policy for granting exceptions to the New Measures data reporting requirements under the HHVBP Model during the COVID-19 PHE, including the codification of these changes at 484.315(b), as described in the May 2020 COVID-19 IFC. For example, they must learn how to insert a needle intravenously, administer oxygen, use a nebulizer, place a catheter, to measure the volume of urine. 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. We proposed to establish a new 424.68 that would encapsulate the preponderance of our home infusion therapy supplier enrollment provisions. We will repost the case-mix weights for CY 2021 on the HHA Center and PDGM web pages. The average salary for a Registered Nurse is $44.22 per hour in New Jersey. Section 1842(u)(7)(F) of the Act defines eligible home infusion supplier as a supplier who is enrolled in Medicare as a pharmacy that provides external infusion pumps and external infusion pump supplies, and that maintains all pharmacy licensure requirements in the State in which the Start Printed Page 70333applicable infusion drugs are administered. The Form CMS-855, which can be submitted via paper or electronically through the internet-based Provider Enrollment, Chain, and Ownership System (PECOS) process (SORN: 09-70-0532, Provider Enrollment, Chain, and Ownership System) collects important information about the provider or supplier; such data includes, but is not limited to, general identifying information (for example, legal business name), licensure and/or certification data, and practice locations. The home health payment update percentage for CY 2021 is 2.0 percent. We received no comments concerning our projected application fee transfers and are therefore finalizing them as proposed. CPT is a trademark of the AMA. Using this approach, we now convert the national per-visit rates into per 15-minute unit rates. Finally, several commenters recommended that CMS consider implementing a 5 percent cap, similar to that which we proposed for CY 2021, for years beyond the implementation of the revised OMB delineations. Comment: The commenters supported CMS's proposal to remove the provisions related to test transmission of OASIS data by a new HHA at 484.45(c)(2). The per-visit rates are then updated by the CY 2021 HH payment update of 2.0 percent for HHAs that submit the required quality data and by 0.0 percent for HHAs that do not submit quality data. the material on FederalRegister.gov is accurately displayed, consistent with Actual (unrounded) figures were used to calculate percentage change. 11. 0 Each 30-day period of care is classified into one of two admission source categoriescommunity or institutionaldepending on what healthcare setting was utilized in the 14 days prior to home health. 8. Our members represent more than 60 professional nursing specialties. These tools are designed to help you understand the official document 4. In the CY 2019 HH PPS final rule with comment period (83 FR 56492), we finalized our policy that the LUPA thresholds for each PDGM payment group would be reevaluated every year based on the most current utilization data available at the time of rulemaking. The proportion of additional costs over the outlier threshold amount paid as outlier payments is referred to as the loss-sharing ratio. Final Decision: After considering the comments received in response to the proposed CY 2021 annual payment update and for the reasons discussed previously, we are finalizing the CY 2021 national, standardized 30-day payment rates, the per-visit payment rates and the home health payment update percentage of 2.0 percent for CY 2021 as proposed. Overview of the Home Health Groupings Model. and meet the definition of a home infusion drug with coverage of home infusion therapy services under payment category 2. Section 1834(u)(6) of the Act requires that prior to the furnishing of home infusion therapy services to an individual, the physician who establishes the plan described in section 1861(iii)(1) of the Act for the individual shall provide notification (in a form, manner, and frequency determined appropriate by the Secretary) of the options available (such as home, physician's office, hospital outpatient department) for the furnishing of infusion therapy under this part. Payment to a qualified home infusion therapy supplier is for an infusion drug administration calendar day in the individual's home, which, in accordance with section 1834(u)(7)(E) of the Act, refers to payment only for the date on which professional services were furnished to administer such drugs Start Printed Page 70335to such individual. Some states and hospital systems may require hourly rates. ++ Review history and assess current physical and mental status, including obtaining vital signs; ++ Assess any adverse effects or infusion complications; ++ Evaluate family and caregiver support ; ++ Review prescribed treatment and any concurrent oral and/or over-the-counter treatments; and. The CY 2021 national, standardized 30-day period payment rate for an HHA that does not submit the required quality data is updated by the CY 2021 home health payment update of 2.0 percent minus 2 percentage points and is shown in Table 8. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/internet-Only-Manuals-IOMs-Items/CMS014961.html. Specifically, during the COVID-19 PHE, to the extent that the data that participating HHAs in the nine HHVBP Model states are required to report are the same data that those HHAs are also required to report for the HH QRP, HHAs are required to report those data for the HHVBP Model in the same time, form and manner that HHAs are required to report those data for the HH QRP. 3. 7,861 jobs. 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 further believe that using the September 2018 OMB delineations would increase the integrity of the HH PPS wage index by creating a more accurate representation of geographic variation in wage levels. Currently, the only rural area without a hospital from which hospital wage data could be derived is Puerto Rico. Section 1886(b)(3)(B)(xi)(II) of the Act defines the productivity adjustment to be equal to the 10-year moving average of change in annual economy-wide private nonfarm business multifactor productivity (MFP) (as projected by the Secretary for the 10-year period ending with the applicable fiscal year, calendar year, cost reporting period, or other annual period) (the MFP adjustment). CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. These payment category amounts are set equal to 4 hours of infusion therapy administration services in a physician's office for each infusion drug administration calendar day, regardless of the length of the visit. An individualized plan of care must be established and periodically reviewed by the certifying physician or allowed practitioner. The previous data submission system limited HHAs to only two users who had permission to access the system, and required the use of a virtual private network (VPN) to access CMSNet. The list of GAFs by locality for this final rule is available as a downloadable file at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Home-Infusion-Therapy/Overview.html. ++ Ensures the safe and effective provision and administration of home infusion therapy on a 7-day-a-week, 24-hour-a-day basis. Because we believe that using the new OMB delineations would create a more accurate payment adjustment for differences in area wage levels we proposed to include a cap on the overall decrease in a geographic area's wage index value. We note that in response to the CY 2021 HH PPS proposed rule, we received approximately 162 timely pieces of correspondence from the Start Printed Page 70301public, including from home health agencies, national and state provider associations, patient and other advocacy organizations, nurses, and other healthcare professionals. In response to the comment regarding the new OMB delineations and the potential effect on the rural add-on payment, section 50208(a)(1)(D) of the BBA of 2018 (revising section 421 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. Nurses can also choose a . The Form CMS-855B is typically completed by suppliers other than individual physicians and practitioners. Payment category 2 comprises subcutaneous infusions for therapy or prophylaxis, including, but not limited to, certain subcutaneous immunotherapy infusions. In 2020, pay per visit can be a compensation model fraught with challenges, Home Healthcare Solutions President Jnon Griffin said Wednesday on the same panel. In section V.B. For this same reason, we also did not grant further exceptions to HHVBP Model New Measure data submission periods beyond the July 2020 submission period. You also have to factor in your drive time. Prior to the implementation of the 30-day unit of payment, LUPA episodes were eligible for a LUPA add-on payment if the episode of care was the first or only episode in a sequence of adjacent episodes. what area of the country are you in, was wondering it that makes a difference. Rural Add-On Payments for CYs 2019 Through CY 2022, E. Payments for High-Cost Outliers Under the HH PPS, 2. To enroll in the Medicare program as a home infusion therapy supplier, a home infusion therapy supplier must meet all of the following requirements: (1)(i) Fully complete and submit the Form CMS-855B application (or its electronic or successor application) to its applicable Medicare contractor. This is complex and varies between regions . www.cms.gov/medicare-coverage-database/reports/sad-exclusion-list-report.aspx?bc=AQAAAAAAAAAAAA%3D%3D. https://med.noridianmedicare.com/documents/2230703/7218263/External+Infusion+Pumps+LCD+and+PA. Temporary Transitional Payment for Home Infusion Therapy Services for CYs 2019 and 2020. In the CY 2020 HH PPS final rule with comment period (84 FR 60478), we finalized our proposal to maintain the three payment categories utilized under the temporary transitional payments for home infusion therapy services. Implementing this as a condition for payment is a patient safeguard to ensure that HHAs are carefully evaluating not only whether a patient is an appropriate candidate for services furnished via telecommunications technology, but also that once implemented into the patient's care, it is benefitting the patient. We believed this was a reasonable barometer with which to establish estimates (strictly for purposes of the final rule) of the fee amounts in the first 3 CYs of this rule (that is, 2021, 2022, and 2023). Each HHRG has an associated case-mix weight that is used in calculating the payment for a 30-day period of care. We also noted that while we are able to extract the claims-based data from submitted Medicare FFS claims, we may need to assess the appropriateness of using the claims data submitted for the period of the PHE for COVID-19 for purposes of performance calculations under the HHVBP Model. Section 1895(b)(3)(A)(i) of the Act requires that the standard prospective payment rate and other applicable amounts be standardized in a manner that eliminates the effects of variations in relative case-mix and area wage adjustments among different home health agencies in a budget-neutral manner. . Whether the patient goes to the clinic stay in the hospital or is discharged from the hospital Nurses always educate people about things related to their health. the official SGML-based PDF version on govinfo.gov, those relying on it for In addition, the single payment amount is required to be adjusted to reflect geographic wage index and other costs that may vary by region, patient acuity, and complexity of drug administration. MedPAC reiterated its recommendation from its March 2020 report to the Congress to reduce home health payments by 7 percent in CY 2021. However, we also note that the 10-year moving average of MFP based on the third quarter 2020 forecast is also 0.3 percentage points. Since CY 2020 was the first year of PDGM, we did not propose to recalibrate the PDGM case-mix weights and; therefore, a case-mix budget neutrality factor is not needed. Subparagraphs (A) and (B) of section 1861(iii)(1) of the Act set forth beneficiary eligibility and plan of care requirements for home infusion therapy. In accordance with section 1861(iii)(1)(A) of the Act, the beneficiary must be under the care of an applicable provider, defined in section 1861(iii)(3)(A) of the Act as a physician, nurse practitioner, or physician assistant. For purposes of the temporary transitional payments for home infusion therapy services in CYs 2019 and 2020, the term transitional home infusion drug includes the HCPCS codes for the drugs and biologicals covered under the DME LCD for External Infusion Pumps (L33794). 8. Using the proposed CY 2021 PFS rates, we estimate a 19 percent increase in the first visit payment amount and a 1.18 percent decrease in subsequent visit amounts. SPONSORED BY: New HHAs do not yet have a CMS Certification Number (CCN). Section III.B. The CY 2019 through CY 2022 rural add-on percentages outlined in law are shown in Table 11. where you can start, Often when we think of nurses the first thought that came to mind was a person in a white uniform who was responsible for helping doctors, but there was more to this profession. Comment: A commenter remarked on the proposed FDL ratio of 0.63 that was in the CY 2021 HH PPS proposed rule and stated that the FDL ratio that was finalized for CY 2020 was 0.56. A CMS or Medicare contractor systems issue that is beyond the control of the home health agency. While ZipRecruiter is seeing annual salaries as high as $143,500 and as low as $39,000, the majority of HOME Health Registered Nurse salaries currently range between $67,500 (25th percentile) to $100,500 (75th percentile) with top earners (90th percentile) making $124,500 annually across the United States. In the CY 2015 HH PPS final rule (79 FR 66085 through 66087), we adopted OMB's area delineations using a 1-year transition. Because a qualified home infusion therapy supplier is not required to become accredited as a Part B DME supplier or to furnish the home infusion drug, and because payment is determined by the provision of services furnished in the patient's home, we acknowledged in the CY 2019 HH PPS proposed rule the potential for overlap between the new home infusion therapy services benefit and the home health benefit (83 FR 32469). Email | Therefore, regardless of the clinical group assignment, HHAs are required, in accordance with the home health CoPs at 484.60(a)(2), to ensure that the individualized home health plan of care addresses all care needs, including the disciplines to provide such care. while others Specializing in the emergency room. Using existing accreditation statistics and our internal data, we generally estimated that approximately: (1) 600 home infusion therapy suppliers would be eligible for Medicare enrollment under our provisions, all of whom would enroll in the initial year thereof; and (2) 50 home infusion therapy suppliers would annually enroll in Year 2 and in Year 3. L. 105-33, enacted August 5, 1997), significantly changed the way Medicare pays for Medicare home health services. 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