• The Medicare Home Health Prospective Payment System (HH PPS) Rate Update for CY 2010 Final Rule (CMS-1560-F) contained some important revisions to the level of outlier payments available for 60-day home health episodes of care that carry unusually high costs. For CY 2010, CMS will cap home health outlier payments at 10 percent per HHA and target total aggregate outlier payments at 2.5 percent of all HH PPS payments. Final instructions (Change Request/Transmittal) describing the changes that will be made by Medicare contractors to implement this new outlier policy are currently being developed and are expected to be released sometime in early December. HHAs should note that HH PPS billing instructions are not changing as a result of this policy. CMS will provide an update as to the status of those instructions at out next Open Door Forum (ODF) on Wednesday, December 2nd. (posted 11/9/2009)

• CMS-1560-F (Display Date:  October 30, 2009; Publication Date: November 10, 2009): The Centers for Medicare & Medicaid Services (CMS) issued a final rule to update the Medicare Home Health Prospective Payment (HH PPS) rates for calendar year (CY) 2010.  This final rule continues with the previously promulgated 2.75 percent reduction to the HH PPS rates in CY 2010 (to account for the increase in case-mix not due to the underlying condition of the home health patient), updates the HH PPS rates by a 2.0 percent home health market basket update, and as part of efforts to address potential fraud and abuse regarding outlier payments to home health agencies revises its outlier policy (for CY 2010) by capping outlier payments at 10% of total HH PPS payments, updating the fixed dollar loss ratio to 0.67, and targeting outlier payments to be no more than 2.5 percent of total HH PPS payments  (returning 2.5% back into the base rate).  CMS will  also require the submission of OASIS as a condition for payment,  and is implementing a new version of OASIS, OASIS-C, beginning January 1, 2010.  CMS is also adding payment safeguards to improve the enrollment process, improve quality of care, and reduce fraud.  See also CY 2010 Home Health PPS Wage Index File [ZIP, 37KB] (posted November 5, 2009)
• CMS is posting Abt Associates' August 20, 2009 "Analysis of 2006-2007 Home Health Case-mix Change" report. This report is an update to the original April 2008 "Refinement of Medicare's Home Health Prospective Payment System: Final Report" and describes updates to the home health case-mix change analysis since the CY 2008 HH PPS Final Rule (CMS-1541-FC), up to and through the recently published CY 2010 proposed rule (CMS-1560-P). (posted 8/24/2009)

• An incorrect version of the wage index was inadvertently published at the Federal Register as part of CMS-1560-P (Publication Date: August 6, 2009). Consequently, the Federal Register reissued the Medicare Home Health Prospective Payment (HH PPS) rates for Calendar Year (CY) 2010 proposed rule (CMS-1560-P), with the correct wage index addenda.  It displayed on 8/12/09 and published on 8/13/09 at the Federal register. The comment period is not affected by this reissuance. (posted 8/13/2009)

• CMS is updating the HH PPS Grouper primarily due to changes in ICD-9-CM coding (effective October 1, 2009). CMS is providing an updated HH PPS Grouper Software Package (Version V2409). The materials provided include an updated version of the grouper logic (JAVA source code) and associated tables, an updated JAVA.dll software module and updated test cases to be used by those developing their own software to implement the grouper logic. The grouper has been restructured to use JAVA source code which is a change from previous versions. Accompanying the release is a Java .dll bridge which will enable users to call the grouper from C based applications. These enhancements will permit users to utilize the source code as a template when building their own programs ensuring greater consistency. A further break from previous releases is the process of ICD-9-CM validation. The HH PPS Grouper will require a valid ICD-9-CM code to obtain points when scoring assignments. This replaces the edits previously contained within the grouping logic. A table of valid ICD-9-CM codes for the corresponding periods is contained in the grouper release. The 2010 version of the Grouper Software package is available from the Home Health Case Mix Grouper Software Package web page in the Downloads section. (posted 7/30/2009)

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