There are at least two potential problems with classifying RNs, PTs, OTs, and SLPs as exempt from overtime but paying them on a per visit basis: 1. 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. Therefore, we are finalizing the removal of this requirement at 484.45(c)(2) for HHAs to successfully transmit test data to the QIES ASAP System or CMS OASIS contractor. In response to comments regarding the inclusion of telehealth services as billable visits, we refer readers to section III.F. For more information on the policies we have adopted for the HH QRP, we refer readers to the following: For a detailed discussion of the considerations we historically use for measure selection for the HH QRP quality, resource use, and others measures, we refer readers to the CY 2016 HH PPS final rule (80 FR 68695 through 68696). I just got a part-time job at an HHC agency in Florida. in fact Many nurses agree that nursing is not just a career or a career. (ii) Any of the applicable denial reasons in 424.530. Finally, a commenter recommended that, with the sunset of the rural add-on payment, CMS should include telehealth or virtual visits as a billable visit to help offset the financial burden of rural HHAs. CY 2019 HH PPS final rule with comment period (, CY 2020 HH PPS final rule with comment period (. Likewise, the 5 percent cap on wage index decreases will help effectively mitigate any significant decreases in wage index values for CY 2021 for those HHAs in CBSAs where there would be decreases in the wage index due to the adoption of the new OMB delineations. L. 114-255) (Cures Act) created a separate Medicare Part B benefit category under section 1861(s)(2)(GG) of the Act for coverage of home infusion therapy services needed for the safe and effective administration of certain drugs and biologicals administered intravenously, or subcutaneously for an administration period of 15 minutes or more, in the home of an individual, through a pump that is an item of DME. Step-By-Step Pay Equity Analysis Guide Product Guide By clicking Download Product Guide, Do you know what your employees really want for the holidays? In this Issue, Documents We stated that the claim should include the length of time, in 15-minute increments, for which professional services were furnished. In paragraph (a) thereof, we proposed to define home infusion therapy supplier (for purposes of 424.68) as a supplier of home infusion therapy that meets all of the following requirements: ++ Furnishes infusion therapy to individuals with acute or chronic conditions requiring administration of home infusion drugs. It is possible that not all commenters reviewed this year's rule in detail, and it is also possible that some reviewers chose not to comment on the proposed rule. [12] As finalized in the CY 2020 HH PPS final rule with comment period and as set forth in regulation at 484.205(g)(4), an exceptional circumstance may be due to, but is not limited to the following: If an HHA believes that there is a circumstance that may qualify for an exception, the home health agency must fully document and furnish any requested documentation to CMS for a determination of exception. Each 30-day period of care will be placed into one of three functional impairment levels, low, medium, or high, based on responses to certain OASIS functional items associated with grooming, bathing, dressing, ambulating, transferring, and risk for hospitalization. Therefore, the final CY 2021 home health payment update percentage for CY 2021 is 2.0 percent (HHA market basket percentage increase of 2.3 percent less 0.3 percentage points MFP adjustment). As for the specific NPI situation the commenters raised, we refer the latter to the 2004 NPI Final Rule (https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/downloads/NPIfinalrule.pdf), the NPI regulations at 45 CFR part 162, subpart D, and the Medicare Expectations Subpart Paper (the text of which is in CMS Publication 100-08, Medicare Program Integrity Manual, Chapter 15, section 15.3, at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pim83c15.pdf.) related to patient care In short, nurses act as a link between departments. Overview of the Home Health Prospective Payment System (HH PPS), B. Nurses must renew their SNB practicing certificate annually, as mentioned above. 1302, 1395hh, and 1395rr(b)(l). In the CY 2021 HH PPS proposed rule that appeared in the June 30, 2020 Federal Register (85 FR 39408), we proposed changes to the payment rates, factors, and other payment and policy-related changes to programs associated with under the HH PPS for CY 2021 and home infusion therapy services benefit for CY 2021. Section 210 of the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. These flexibilities include: These flexibilities were provided to help mitigate commenters' concerns about the provision of home health services during the COVID-19 PHE. The quality, utility, and clarity of the information to be collected. These numbers represent the median, which is the midpoint of the ranges from our proprietary Total Pay Estimate model and based on salaries collected from our users. Final Decision: After consideration of public comments, CMS is finalizing the home health payment update percentage for CY 2021 based on the most recent forecast of the HHA market basket percentage increase and MFP adjustment at the time of rulemaking. Durable medical equipment provided as a home health service as defined in section 1861(m) of the Act is paid the fee schedule amount and is not included in the national, standardized 30-day period payment amount. Section 4603(a) of the BBA mandated the development of a HH PPS for all Medicare-covered home health services provided under a plan of care (POC) that were paid on a reasonable cost basis by adding section 1895 of the Act, entitled Prospective Payment for Home Health Services. Section 1895(b)(1) of the Act requires the Secretary to establish a HH PPS for all costs of home health services paid under Medicare. Until the implementation of the HH PPS on October 1, 2000, HHAs received payment under a retrospective reimbursement system. Columbus, IN 47201. Similarly, section 1895(b)(4)(C) of the Act requires the establishment of area wage adjustment factors that reflect the relative level of wages, and wage-related costs applicable to home health services furnished in a geographic area compared to the applicable national average level. Response: We thank the commenters for their recommendations and while we did not propose any changes for CY 2021 relating to the behavior assumptions finalized in the CY 2019 HH PPS final rule with comment period (84 FR 56461), or to the 4.36 percent behavior assumption reduction, finalized in the CY 2020 HH PPS final rule with comment period (84 FR 60519), we want to respond with what CMS is required to do by law. of this rule, we discuss the background and overview of the home infusion therapy services benefit, as well as review the payment policies we finalized in the CY 2020 HH PPS final rule with comment period for the CY 2021 implementation (84 FR 60628). Services for the provision of drugs and biologicals not covered under this definition may continue to be provided under the Medicare home health benefit, and paid under the home health prospective payment system. Comment: Several commenters provided feedback on the Home Health Quality Reporting Program. If an HHA does not become accredited and enrolled as a qualified home infusion therapy supplier and is treating a patient receiving a home infusion drug, the HHA must contract with a qualified home infusion therapy supplier to furnish the services related to the home infusion drug. Concerns related to potential discrimination issues under section 504, section 1557 of the ACA, and Title II of the ADA[6] The requirements include the implementation of a HH PPS for home health services, consolidated billing requirements, and a number of other related changes. The $390 million increase in estimated payments for CY 2021 reflects the effects of the CY 2021 home health payment update percentage of 2.0 percent ($410 million increase) and an estimated 0.1 percent decrease in payments due to the rural add-on percentages mandated by the Bipartisan Budget Act of 2018 for CY 2021 ($20 million decrease). The average turnover rate for RNs in 2019 was 20.55%; 25.85% in 2020; and 32.25% in 2021. Medicare-Approved Amount. For the purpose of a Request for Anticipated Payment (RAP), only the final claim will be adjusted to reflect the admission source. For HHAs that do not submit the required quality data for CY 2021, the home health payment update percentage would be 0.0 percent (2.0 percent minus 2.0 percentage points). In accordance with the conforming amendment in section 5012(c)(3) of the 21st Century Cures Act, which amended section 1861(m) of the Act to exclude home infusion therapy from the definition of home health services, we proposed to amend 409.49 to exclude services covered under the home infusion therapy services benefit from the home health benefit. The new CMS data submission system, internet Quality Improvement & Evaluation System (iQIES), is now internet-based. The top employer was hospitals, where 1,713,120 RNs averaged $ 79,460 per year. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. For general information about the Home Health Prospective Payment System (HH PPS), send your inquiry via email to: HomehealthPolicy@cms.hhs.gov. 27. A partial payment adjustment as set forth in 484.205(d)(2) and 484.235. 25. Final Decision: After consideration of the comments received, we are finalizing without modification the policy to align HHVBP Model data submission requirements with any exceptions or extensions granted for purposes of the HH QRP during the COVID-19 PHE, as described in the May 2020 COVID-19 IFC. Section 202 of the Unfunded Mandates Reform Act of 1995 (UMRA) also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. Mapping out a clear pay structure and expectations for field staff is imperative for success in home-based care, particularly as margins become slimmer and the Patient-Driven Groupings Model (PDGM) takes hold. (All rates above represent the national average hourly rate.). These provisions serve as the basis for determining the scope of the home infusion drugs eligible for coverage of home infusion therapy services, outlining beneficiary qualifications and plan of care requirements, and establishing who can bill for payment under the benefit.Start Printed Page 70334. In the CY 2020 HH PPS final rule with comment period, we finalized provisions regarding payment for home infusion therapy services for CY 2021 and subsequent years in order to allow adequate time for eligible home infusion therapy suppliers to make any necessary software and business process changes for implementation on January 1, 2021. RN Pay Per Visit Grid RHCD Years of Service Year 1-3 Year 4-6 Year 7-9 Year 10+ Labor Pool** SN, SNDC Weekday. Section 1861(iii)(3)(D)(i) of the Act defines a qualified home infusion therapy supplier as a pharmacy, physician, or other provider of services or supplier licensed by the State in which the pharmacy, physician, or provider of services or supplier furnishes items or services. Section 1895(b)(1) of the Act requires the Secretary to establish a HH PPS for all costs of home health services paid under Medicare. The Forms CMS-855S and CMS-855B are separate applications specifically tailored to capture certain information unique to the different provider and supplier types they pertain to; as an illustration, allowing an entity to enroll as a DMEPOS supplier via the Form CMS-855B (as opposed to the DMEPOS-specific Form CMS-855S) would deprive the NSC of important data needed to verify the entity's compliance with all DMEPOS enrollment standards and requirements. Change to the Conditions of Participation (CoPs) OASIS Requirements, C. Finalization of the Provisions of the May 2020 Interim Final Rule With Comment Period Relating to the Home Health Value-Based Purchasing Model (HHVBP), 2. https://med.noridianmedicare.com/documents/2230703/7218263/External+Infusion+Pumps+LCD+and+PA. 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. We also recognize that different types of entities are in many cases affected by mutually exclusive sections of this final rule, and therefore for the purposes of our estimate we assume that each reviewer reads approximately 50 percent of the rule. 8. You can get continuous education through your own efforts. These regulation changes were not time limited to the period of the COVID-19 PHE. In some cases there is also added differentials for weekends and holidays +5-10. This drug was included as a transitional home infusion drug since the definition of such drug in section 1834(u)(7)(A)(iii) of the Act does not exclude self-administered drugs or biologicals on a SAD exclusion list under the temporary transitional payment. Comment: A commenter supported our establishment of measures designed to prevent fraudulent and unqualified home infusion therapy suppliers from entering Medicare. 18-04 for the home health wage index effective beginning in CY 2021. describe the payment categories and payment amounts for home infusion therapy services for CY 2021, as well as payment adjustments for CY 2021 home infusion therapy services. In addition, although we did not propose any changes the national, standardized 30-day period payment rate for CY 2021, except for the statutorily-required routine payment rate update, we received numerous comments regarding the behavior assumptions adjustment and these are summarized in this section of this final rule. ++ Education on lifestyle and nutritional modifications; ++ Education regarding drug mechanism of action, side effects, interactions with other medications, adverse and infusion-related reactions; ++ Education regarding therapy goals and progress; ++ Instruction on administering pre-medications and inspection of medication prior to use; ++ Education regarding household and contact precautions and/or spills; ++ Communicate with patient regarding changes in condition and treatment plan; ++ Monitor patient response to therapy; and. at the end of the course you will learn how to help with medication administration. for better understanding how a document is structured but Care coordination between the physician and DME supplier, although likely to include review of the services indicated in the home infusion therapy supplier plan of care, is paid separately from the payment under the home infusion therapy services benefit. Easily apply on Indeed. This final rule establishes Medicare provider enrollment policies for qualified home infusion therapy suppliers. However, we have historically adopted the latest OMB delineations as we believe that implementing the new OMB delineations would result in wage index values being more representative of the actual costs of labor in a given area. For a given level of outlier payments, there is a trade-off between the values selected for the FDL ratio and the loss-sharing ratio. OMB defines a Micropolitan Statistical Area as a CBSA associated with at least one urban cluster that has a population of at least 10,000, but less than 50,000 (75 FR 37252). Several commenters stated concerns regarding additional costs of personal protective equipment (PPE) and other infection control measures due to the COVID-19 PHE, and recommended CMS to include a PPE cost add-on to the 2020 30-day period payment and per visit payment rates. These bulletins established revised delineations for Metropolitan Statistical Areas, Micropolitan Statistical Areas, and Combined Statistical Areas, and provided guidance on the use of the delineations of these statistical areas. Since the inception of the HH PPS, we have used inpatient hospital wage data in developing a wage index to be applied to home health payments. https://med.noridianmedicare.com/documents/2230703/7218263/External+Infusion+Pumps+LCD+and+PA. The net transfer impact related to the changes in payments under the HH PPS for CY 2021 is estimated to be $390 million (1.9 percent). THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. We explained that under this policy, to the extent CMS has granted an exception to the HH QRP (for 2019 Q4 and 2020 Qs 1 and 2 as noted in the May 2020 COVID-19 IFC and below in this section), or may grant any future exceptions or extensions under this same program for other CY 2020 reporting periods, HHAs in the nine HHVBP Model states do not need to separately report these measures for purposes of the HHVBP Model, and those same exceptions apply to the submission of those same data for the HHVBP Model. Commenters stated that behavior change would not occur 100 percent of the time for all 30-day periods of care. This means that the LUPA threshold for each 30-day period of care varies depending on the PDGM payment group to which it is assigned. All Rights Reserved (or such other date of publication of CPT). Section 1834(u)(7)(C) of the Act assigns transitional home infusion drugs, identified by the HCPCS codes for the drugs and biologicals covered under the DME LCD for External Infusion Pumps (L33794),[15] Therefore, they used a fake or test CCN in order to transmit test data to the Quality Improvement & Evaluation System Assessment Submission & Processing (QIES ASAP) System or CMS OASIS contractor. Each 30-day period of care is grouped into one of 12 clinical groups that describe the primary reason for which patients are receiving home health services under the Medicare home health benefit. documents in the last year, 83 In new paragraph (e)(3), we proposed that a home infusion therapy supplier may appeal the revocation of its enrollment under part 498. Finally, section 5012(c)(3) of the 21st Century Cures Act amended section 1861(m) of the Act to exclude home infusion therapy from the HH PPS beginning on January 1, 2021. These sections specify that the services performed by these entities are only covered if the entity performs the services in accordance with state law and state scope of practice rules for PAs, NPs, and CNSs in the state in which such practitioner's professional services are furnished. With that in mind, providers need to find one model that works for both employees and their bottom line. endstream endobj startxref Another commenter requested that we extend reporting exceptions for Quarters 3 and 4 of CY 2020, stating that this would continue to provide regulatory relief for quality reporting programs across Medicare Fee-for-Service payment systems. In accordance with section 1895(b)(3)(B)(v) of the Act and 484.225(c), for an HHA that does not submit home health quality data, as specified by the Secretary, the unadjusted national prospective 30-day period rate is equal to the rate for the previous calendar year increased by the applicable home health payment update, minus 2 percentage points. . In conjunction with our finalized policy to change to a cost-per-unit approach to estimate episode costs and determine whether an outlier episode should receive outlier payments, in the CY 2017 HH PPS final rule we also finalized the implementation of a cap on the amount of time per day that would be counted toward the estimation of an episode's costs for outlier calculation purposes (81 FR 76725). The supplier may subcontract with a pharmacy, physician, other qualified supplier or provider of medical services, in order to meet these requirements. 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. Since 2006, we have taken various steps via rulemaking to outline our enrollment procedures. For this analysis, we used an analytic file with linked CY 2019 OASIS assessments and home health claims data for dates of service that ended on or before December 31, 2019. Qualified Home Infusion Therapy Suppliers and Professional Services, (4). Comments regarding the update to the CY 2021 national, standardized 30-day period payment amount are summarized in this section of this final rule. We will consider potential options for collecting data regarding the use of telecommunications technology on home health claims. Holidays +5-10 Health Quality Reporting Program find one model that works for employees! 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