Navigating the 2025 Home Health Payment Landscape
The Centers for Medicare & Medicaid Services (CMS) released the Calendar
Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Final Rule
on November 1, 2024. This final rule outlines critical updates for Home
Health Agencies (HHAs) regarding payment policies and rates for CY 2025.
Here’s a breakdown of the key takeaways for HHAs:
Payment and Policy Updates
- Modest Payment Increase: HHAs can expect a 0.5% increase in overall Medicare payments compared to 2024. This increase is a net result of a 2.7% base payment update, a 1.8% decrease for permanent
adjustments due to behavior changes, and a 0.4% decrease due to an updated fixed-dollar loss ratio. - Permanent Behavior Adjustments: The final rule implements a -1.975% permanent adjustment to the CY 2025 payment rate. This accounts for the impact of implementing the Patient-Driven Groupings Model (PDGM) and the 30-day unit of payment.
- PDGM Case-Mix Weight Recalibration: CMS has recalibrated PDGM case-mix weights and LUPA thresholds using CY 2023 data to ensure more accurate payments reflecting the types of patients HHAs serve.
- Home Health Wage Index Update: The final rule adopts the most recent OMB Core-Based Statistical Area (CBSA) delineations for the home health wage index, reflecting population shifts and labor market changes.
- Home Health Conditions of Participation (CoPs) Updates:
- New Standard: HHAs must develop and implement a patient acceptance-to-service policy considering factors like patient needs, caseload, staffing levels, and staff competencies.
- Public Information Requirement: HHAs must make accurate information regarding services offered and any limitations publicly available and reviewed regularly.
Additional Updates
- Home Health (HH) Quality Reporting Program (QRP) Updates: Four new social determinants of health (SDOH) assessment data elements will be collected through the OASIS instrument starting in CY 2027.
- Expanded Home Health Value-Based Purchasing (HHVBP) Model: The final rule summarizes comments received on potential future performance measures for the HHVBP Model, including functional measures and family caregiver status.
- Long-Term Care (LTC) Facility Acute Respiratory Illness Data Reporting: LTC facilities will be required to report standardized data on COVID-19, influenza, and RSV infections starting January 1, 2025.
We highly recommend visiting the CMS website for the complete CY 2025
Home Health Prospective Payment System Final Rule: Click Here
By partnering with Codingdepartment.com, you can ensure that your home health business is compliant with the new HH PPS rule and that you are receiving the maximum reimbursement for the services you provide. Contact us today to learn more about how we can help your HHA thrive.
