Medicare Program; Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin (IVIG) Items and Services Rate Update; and Other Medicare Policies

DEPARTMENT OF HEALTH AND HUMAN SERVICES <SUBAGY>Centers for Medicare & Medicaid Services</SUBAGY> <CFR>42 CFR Parts 424, 483, and 484</CFR> <DEPDOC>[CMS-1803-P]</DEPDOC> <RIN>RIN 0938-AV28</RIN> <SUBJECT>Medicare Program; Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin (IVIG) Items and Services Rate Update; and Other Medicare Policies</SUBJECT> <HD SOURCE="HED">AGENCY:</HD> Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS). <HD SOURCE="HED">ACTION:</HD> Proposed rule. <SUM> <HD SOURCE="HED">SUMMARY:</HD> This proposed rule would set forth routine updates to the Medicare home health payment rates; the payment rate for the disposable negative pressure wound therapy (dNPWT) devices; and the intravenous immune globulin (IVIG) items and services payment rate for CY 2025 in accordance with existing statutory and regulatory requirements. In addition, it proposes changes to the Home Health Quality Reporting Program (HH QRP) requirements and provides an update on potential approaches for integrating health equity in the Expanded Health Value Based Purchasing (HHVBP) Model. It also proposes a new standard for acceptance to service policy in the HH conditions of participation (CoPs) and includes requests for information (RFIs) soliciting input on permitting rehabilitative therapists to conduct the initial and comprehensive assessment and the factors that may influence the patient referral and intake processes. Lastly, it proposes updates to provider and supplier enrollment requirements and changes to the long-term care reporting requirements for acute respiratory illnesses. </SUM> <DATES> <HD SOURCE="HED">DATES:</HD> To be assured consideration, comments must be received at one of the addresses provided in the <E T="02">ADDRESSES</E> section, no later than 5 p.m. EDT on August 26, 2024. </DATES> <HD SOURCE="HED">ADDRESSES:</HD> In commenting, please refer to file code CMS-1803-P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. Comments, including mass comment submissions, must be submitted in one of the following three ways (please choose only one of the ways listed): 1. <E T="03">Electronically</E> . You may (and we encourage you to) submit electronic comments on this regulation to <E T="03">https://www.regulations.gov.</E> Follow the instructions under the “submit a comment” tab. 2. <E T="03">By regular mail</E> . You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1803-P, P.O. Box 8013, Baltimore, MD 21244-8013. Please allow sufficient time for mailed comments to be received before the close of the comment period. 3. By express or overnight mail. You may send written comments via express or overnight mail to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1803-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850. For information on viewing public comments, we refer readers to the beginning of the <E T="02">SUPPLEMENTARY INFORMATION</E> section. <FURINF> <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD> Brian Slater, (410) 786-5229, for home health and home IVIG payment inquiries. For general information about the Home Health Prospective Payment System (HH PPS), send your inquiry via email to <E T="03">HomeHealthPolicy@cms.hhs.gov.</E> For information about the Home Health Quality Reporting Program (HH QRP), send your inquiry via email to <E T="03">HHQRPquestions@cms.hhs.gov.</E> For more information about the expanded Home Health Value-Based Purchasing Model, please visit the Expanded HHVBP Model web page at <E T="03">https://innovation.cms.gov/innovation-models/expanded-home-health-value-based-purchasing-model.</E> Frank Whelan (410) 786-1302, for Medicare provider and supplier enrollment inquiries. Mary Rossi-Coajou at <E T="03">mary.rossi-coajou@cms.hhs.gov</E> or Molly Anderson at <E T="03">molly.anderson@cms.hhs.gov,</E> for more information about the home health conditions of participation (HH CoPs). Kim Roche ( <E T="03">kim.roche1@cms.hhs.gov</E> ), for more information about the long-term care requirements for participation. </FURINF> <SUPLINF> <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD> <E T="03">Inspection of Public Comments:</E> All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following website as soon as possible after they have been received: <E T="03">https://www.regulations.gov/.</E> Follow the search instructions on that website to view public comments. <HD SOURCE="HD1">Table of Contents</HD> <EXTRACT> <FP SOURCE="FP-2">I. Executive Summary</FP> <FP SOURCE="FP1-2">A. Purpose and Legal Authority</FP> <FP SOURCE="FP1-2">B. Summary of the Provisions of This Proposed Rule</FP> <FP SOURCE="FP1-2">C. Summary of Costs, Transfers, and Benefits</FP> <FP SOURCE="FP-2">II. Home Health Prospective Payment System</FP> <FP SOURCE="FP1-2">A. Overview of the Home Health Prospective Payment System</FP> <FP SOURCE="FP1-2">B. Monitoring the Effects of the Implementation of PDGM</FP> <FP SOURCE="FP1-2">C. Proposed CY 2025 Payment Adjustments Under the HH PPS</FP> <FP SOURCE="FP1-2">D. Proposed CY 2025 Home Health Low Utilization Payment Adjustment (LUPA) Thresholds, Functional Impairment Levels, Comorbidity Sub-Groups, Case-Mix Weights, and Reassignment of Specific ICD-10-CM Codes Under the PDGM</FP> <FP SOURCE="FP-2">III. Home Health Quality Reporting Program (HH QRP)</FP> <FP SOURCE="FP1-2">A. Background and Statutory Authority</FP> <FP SOURCE="FP1-2">B. Summary of the Provision of This Proposed Rule</FP> <FP SOURCE="FP1-2">C. Quality Measures Currently Adopted for the CY 2024 HH QRP</FP> <FP SOURCE="FP1-2">D. Proposal To Collect Four New Items as Standardized Patient Assessment Data Elements and Modify One Item Collected as a Standardized Patient Assessment Data Element Beginning With the CY 2027 HH QRP</FP> <FP SOURCE="FP1-2">E. Proposal To Update OASIS All-Payer Data Collection</FP> <FP SOURCE="FP1-2">F. Form, Manner, and Timing of Data Submission Under the HH QRP</FP> <FP SOURCE="FP1-2">G. HH QRP Quality Measure Concepts Under Consideration for Future Years—Request for Information (RFI)</FP> <FP SOURCE="FP-2">IV. The Expanded Home Health Value Based Purchasing (HHVBP) Model</FP> <FP SOURCE="FP1-2">A. Background</FP> <FP SOURCE="FP1-2">B. Request for Information on Future Performance Measure Concepts for the Expanded HHVBP Model</FP> <FP SOURCE="FP1-2">C. Future Approaches to Health Equity in the Expanded HHVBP Model</FP> <FP SOURCE="FP1-2">D. Social Risk Factors</FP> <FP SOURCE="FP1-2">E. Approaches to a Potential Health Equity Adjustment for the Expanded HHVBP Model</FP> <FP SOURCE="FP1-2">F. Other Health Equity Measures</FP> <FP SOURCE="FP-2">V. Medicare Home Intravenous Immune Globulin (IVIG) Items and Services</FP> <FP SOURCE="FP1-2">A. General Background</FP> <FP SOURCE="FP1-2">B. Scope of Expanded IVIG Benefit</FP> <FP SOURCE="FP1-2">C. Home IVIG Administration Items and Services Payment</FP> <FP SOURCE="FP1-2"> D. Home IVIG Items and Services Payment Rate </FP> <FP SOURCE="FP-2">VI. Home Health CoP Changes and Long Term (LTC) Requirements for Acute Respiratory Illness Reporting</FP> <FP SOURCE="FP1-2">A. Home Health CoP Changes</FP> <FP SOURCE="FP1-2">B. Long-term Care (LTC) Requirements for Acute Respiratory Illness Reporting</FP> <FP SOURCE="FP-2">VII. Provider Enrollment—Provisional Period of Enhanced Oversight</FP> <FP SOURCE="FP1-2">A. Background</FP> <FP SOURCE="FP1-2">B. Proposed Provisions—Provisional Period of Enhanced Oversight (PPEO)</FP> <FP SOURCE="FP-2">VIII. Collection of Information Requirements</FP> <FP SOURCE="FP1-2">A. Statutory Requirement for Solicitation of Comments</FP> <FP SOURCE="FP1-2">B. Information Collection Requirements (ICRs)</FP> <FP SOURCE="FP-2">IX. Regulatory Impact Analysis</FP> <FP SOURCE="FP1-2">A. Statement of Need</FP> <FP SOURCE="FP1-2">B. Overall Impact</FP> <FP SOURCE="FP1-2">C. Detailed Economic Analysis</FP> <FP SOURCE="FP1-2">D. Regulatory Review Cost Estimation</FP> <FP SOURCE="FP1-2">E. Alternatives Considered</FP> <FP SOURCE="FP1-2">F. Accounting Statements and Tables</FP> <FP SOURCE="FP1-2">G. Regulatory Flexibility Act (RFA)</FP> <FP SOURCE="FP1-2">H. Unfunded Mandates Reform Act (UMRA)</FP> <FP SOURCE="FP1-2">I. Federalism</FP> <FP SOURCE="FP1-2">J. Conclusion</FP> <FP SOURCE="FP-2">X. Response to Comments</FP> </EXTRACT> <HD SOURCE="HD1">I. Executive Summary</HD> <HD SOURCE="HD2">A. Purpose and Legal Authority</HD> <HD SOURCE="HD3">1. Home Health Prospective Payment System (HH PPS)</HD> As required under section 1895(b) of the Social Security Act (the Act), this proposed rule would update the CY 2025 payment rates for home health agencies (HHAs) and the CY 2025 payment rate for the disposable negative pressure wound therapy (dNPWT) device. In this proposed rule, we include analysis on home health utilization, as well as analysis determining the difference between assumed versus actual behavior change on estimated aggregate expenditures for home health payments as result of the change in the unit of payment to 30 days and the implementation of the Patient Driven Groupings Model (PDGM) case-mix adjustment methodology. This rule proposes a crosswalk for mappin ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Preview showing 10k of 461k characters. 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