Home Health Prospective Payment System: Case Mix Recalibration Could Take A Big Bite Out Of Your Budget

Why This Topic Matters

The proposal could alter how home health episodes are weighted and how agencies are reimbursed, making it important for organizations that track Medicare payment methodology and budget impact.

Article Sections

1. CMS proposes case mix recalibration for home health

   An overview of the proposed payment system update and the general rationale CMS gives for aligning weights with newer utilization data.

2. Payment impact concerns for agencies

   Industry commentary on how the proposed changes may affect reimbursement patterns across different home health patient groups and therapy utilization levels.

3. OASIS item changes in the case mix model

   Discussion of assessment items CMS proposes to remove from the case mix calculation and related observations about the model update.

4. Model updates and variable changes

   A summary of CMS statements about the revised four-equation model, including changes in variable counts and threshold adjustments.

5. Case mix creep and rate considerations

   Coverage of CMS’s decision not to apply a reduction tied to case mix growth and the industry response to that approach.

6. Recommended next steps for HHAs

   Suggestions from consultants and industry groups about reviewing agency data, evaluating likely impact, and submitting comments to CMS.