Medicare program; home health prospective payment system rate update for calendar year 2012. Final rule.

Publisher: Office of the Federal Register, National Archives and Records Service, General Services Administration; distribution by the Supt. of Docs., U. S. Govt. Print. Off. [etc.] Country of Publication: United States NLM ID: 7808722 Publication Model: Print Cited Medium: Print ISSN: 0097-6326 (Print) Linking ISSN: 00976326 NLM ISO Abbreviation: Fed Regist

Original Publication: Washington, Office of the Federal Register, National Archives and Records Service, General Services Administration; distribution by the Supt. of Docs., U. S. Govt. Print. Off. [etc.]

Home Care Services/*economics ; Medicare/*economics ; Prospective Payment System/*economics; Diagnosis-Related Groups/economics ; Diagnosis-Related Groups/legislation & jurisprudence ; Home Care Services/legislation & jurisprudence ; Humans ; Medicare/legislation & jurisprudence ; Prospective Payment System/legislation & jurisprudence ; United States

This final rule sets forth updates to the home health prospective payment system (HH PPS) rates, including: the national standardized 60-day episode rates; the national per-visit rates; and the low utilization payment amount (LUPA) under the Medicare PPS for home health agencies effective January 1, 2012. This rule applies a 1.4 percent update factor to the episode rates, which reflects a 1 percent reduction applied to the 2.4 percent market basket update factor, as mandated by the Affordable Care Act. This rule also updates the wage index used under the HH PPS, and further reduces home health payments to account for continued nominal growth in case-mix which is unrelated to changes in patient health status. This rule removes two hypertension codes from the HH PPS case-mix system, thereby requiring recalibration of the case-mix weights. In addition, the rule implements two structural changes designed to decrease incentives to upcode and provide unneeded therapy services. Finally, this rule incorporates additional flexibility regarding face-to-face encounters with providers related to home health care.

Date Created: 20111109 Date Completed: 20111111 Latest Revision: 20111107

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