CMS Releases New Home Health Regulation for 2019

A new regulation will bring changes in how Medicare pays for and regulates home health services in 2019.

Included in the regulation released last week are:

  • A 2.2 percent increase in home health payments.
  • Creation of remote patient monitoring benefit for home health patients.
  • Creation of a home infusion benefit.
  • Removal of some measures from the home health quality reporting program.
  • Changes in the home health value-based purchasing model.

For a complete look at the changes coming to how Medicare will treat home health services in 2019, go here to see a CMS fact sheet on the new regulation and here to see the regulation itself.


MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

The issues on MedPAC’s November agenda were:

  • MedPAC’s mandated report on long-term care hospitals
  • patient functional assessment data used in Medicare payment and quality measurement
  • modifying advanced alternative payment model (A-APM) payments
  • modifying the Medicare-dependent hospital program
  • promoting greater Medicare-Medicaid integration in dual-eligible special-needs plans
  • the Medicare Advantage quality bonus program
  • Medicare Advantage encounter data

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.…

New Home Health Reg Brings Changes

A new home health care regulation finalized by the Centers for Medicare & Medicaid Services brings major changes in how Medicare will pay for home health services in the future.

In addition to updating Medicare payment rates, the new rule also:

  • introduces a new home health payment system called the Patient-Driven Groupings Model that de-emphasizes the volume of care provided;
  • authorizes Medicare payments for remote patient monitoring;
  • adds a new home infusion therapy benefit; and
  • reduces the amount of quality data home health providers must report.

To learn more about the new regulation, which takes effect on January 1, 2019, go here to see a CMS news release, here to see a CMS fact sheet, or here to see the 682-page regulation itself.…

CMS Proposes Increasing Use of Telehealth by Medicare Advantage Plans

Medicare Advantage plans would be authorized to make greater use of telehealth services under a new regulation to be proposed by the Centers for Medicare & Medicaid Services.

The proposal, part of a broader regulation addressing a variety of Medicare programs, would authorize wider use of telehealth services in caring for Medicare Advantage enrollees while improving provider payments for those services.

According to a CMS fact sheet about the proposed regulation,

The Bipartisan Budget Act of 2018 allows MA plans to offer “additional telehealth benefits” not otherwise available in Original Medicare to enrollees starting in plan year 2020. Under this proposal, MA plans will have broader flexibility than is currently available in how they pay for coverage of telehealth benefits to meet the needs of their enrollees. In addition, we solicit comment on how to implement the statutory provision that if an MA plan covers a Part B service as an additional telehealth benefit, then the MA plan must also provide the enrollee access to such service through an in-person visit.

The Original Medicare telehealth benefit is narrowly defined and includes restrictions on where beneficiaries receiving care via telehealth can be located. CMS believes that the additional telehealth benefits in

MACPAC: Let’s “hit the pause button” on Medicaid Work Requirements

The non-partisan legislative branch agency that advises Congress and the administration on Medicaid issues will ask the administration to delay approving any more state Medicaid work requirements.

That was the decision reached by the Medicaid and CHIP Payment and Access Commission when it met last week.

MACPAC warned that the work requirement currently being implemented in Arkansas, the first state to introduce such a requirement, is flawed and needs further work before moving forward.  The agency also believes the federal government should increase its oversight of new Medicaid work requirements before additional states begin implementing similar, already-approved Medicaid work requirements.

MACPAC plans to convey its concerns in a letter to Department of Health and Human Services Secretary Alex Azar.

Learn more about MACPAC’s objections to the manner in which Medicaid work requirements are being introduced in this Bloomberg Law article.