Reduced Net Payments for Home Health Care: CMS’s Proposed Rule for Calendar Year 2025

The Centers for Medicare & Medicaid Services (CMS) recently released its proposed rule for the home health prospective payment system for calendar year 2025. This update is expected to result in a reduction of net home health payments by an estimated $280 million, or -1.7%, compared to the current year.

One of the main reasons for this reduction is a 3.0% market basket update, which has been reduced by a 0.5% productivity adjustment. However, CMS is also proposing to decrease the base payment rate by 4.1% due to the implementation of the Patient-driven Groupings Model, which will ultimately reduce total payments by 3.6%.

The American Hospital Association (AHA) has expressed serious concerns about these adjustments, especially given previous downward payment adjustments in recent years. The AHA believes that these cuts could have a significant impact on patient care and quality in home health settings.

CMS is also proposing changes to the HHA Conditions of Participation, including adding a new standard that would require HHAs to develop, consistently apply, and maintain a policy for accepting patients for service. While no quality measures are being added or removed from the HH Quality Reporting Program, CMS is proposing to adopt and modify certain patient assessment items related to health-related social needs.

Furthermore, CMS plans to revise infection prevention and control requirements for long-term care facilities. This includes extending reporting to the Centers for Disease Control and Prevention of a subset of current COVID-19 data elements and requiring reporting for data related to influenza and RSV to begin on January 1, 2025.

Comments on the proposed rule will be accepted by CMS through August 26th