CMS has released the highlights of Fiscal Year (FY) 2016’s Final Rule, which will be officially released on November 5, 2015. You can view and download the entire Rule By clicking HERE.
The projected Final Rule confirms CMS’ plans to implement the Home Health Value-Based Purchasing (HHVBP) Model starting January 1, 2016. Participation in the HHVBP Model will be mandatory for all Medicare-certified HHAs that provide services in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee and Washington. Within the Model, agencies in each state will compete, where payment is tied to quality performance.
Clarification of assigning the seventh character in ICD-10-CM coding is also discussed in the Final Rule. “The assignment of the seventh character should be based on the clinical information from the physician and depends on whether the individual is receiving active treatment for the condition in which the code describes, or if the individual is receiving ongoing care for that condition during the healing and recovery stage (Projected Final Rule 2016).”
Additional highlights: CMS is dropping 4 process measures and 1 of the new reporting measures. The case mix adjustment is being reduced from the proposed level and will be phased in over three years, with the final adjustment at 2.88% compared to the proposed 3.41%. This will be phased in with reductions of 0.97% in 2016, 2017, and 2018 instead of the proposed 1.72% in 2016 and 2017!
We will post additional information after a full review of the 297 page document! I encourage you to download and read the rule so you’ll have the most up-to-date information.