Department of Health and Human Services, Centers for Medicare & Medicaid Services: Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification Requirements for Home Health Agencies and Hospices
GAO-11-236R, Dec 2, 2010
GAO reviewed the Department of Health and Human Services, Centers for Medicare & Medicaid Services' (CMS) new rule on Medicare; Home Health Prospective Payment System rate update for calendar year 2011; and changes in certification requirements for home health agencies and hospices. GAO found that (1) final rule sets forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: the national standardized 60-day episode rates, the national per-visit rates, the nonroutine medical supply (NRS) conversion factors, and the low utilization payment amount (LUPA) add-on payment amounts, under the Medicare prospective payment system for HHAs effective January 1, 2011. The final rule also updates the wage index used under the HH PPS and updates the HH PPS outlier policy. In addition, the final rule revises the home health agency (HHA) capitalization requirements and finalizes a 3.79 percent reduction to rates for CY 2011 to account for changes in case-mix, which are unrelated to real changes in patient acuity. Finally, this rule incorporates new legislative requirements regarding face-to-face encounters with providers related to home health and hospice care; and (2) CMS complied with the applicable requirements in promulgating the rule.