An Overview Of The Home Health Prospective Payment System Rate Update For CY 2009

Abstract

Beginning October 1, 2000, as required by the Balanced Budget Act (BBA) of 1997 and related amendments, Medicare began to reimburse home health agencies for home health services under the new Home Health Prospective Payment System (HHPPS). Under HHPPS, all home health costs for services including medical supplies are paid using a basic unit of payment known as the 60-Day Episode. The amount of the payment is calculated using a national standardized rate, adjusted for case mix and a wage index based on the site of service. For 60-Day Episodes beginning and ending in 2008, the Medicare HHPPS national standardized rate was updated by a new 153 case mix grouping and a new wage index value determined by the site of service for the patient.  The August 29,2008 ( 72 FR 49792) and November 30, 2008( 72 FR 67656) Federal Registers discuss the “Home Health Prospective Payment System Refinement and Rate Update For Calendar Year 2008” changes which include a rebasing and revising of the home health market basket resulting in new labor portion percentage of 77.082 and non-labor portion percentage of 22.918, the new LUPA (Low Utilization Payment Adjustments) per visit payment amounts, the inclusion of an  additional payment for NRS ( Non-Routine Supplies), elimination of the SCIC(Significant Change In Condition) payment, and adjustments to PEP ( Partial Episode Payment) and Outlier payments. This paper discusses an overview of the updated 2008 Medicare HHPPS national standardized rate for CY 2009.