51676 Federal Register /Vol. 82, No. 214/Tuesday, …

1 51676 Federal Register / Vol. 82, No. 214 / tuesday , november 7, 2017 / rules and Regulations DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 484 [CMS 1672 F] RIN 0938 AT01 Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

2 ACTION: Final rule. SUMMARY: This final rule updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60- day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2018. This rule also: Updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the third year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between calendar year (CY) 2012 and CY 2014.

3 And discusses our efforts to monitor the potential impacts of the rebasing adjustments that were implemented in CY 2014 through CY 2017 . In addition, this rule finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model and to the Home Health Quality Reporting Program (HH QRP). We are not finalizing the implementation of the Home Health Groupings Model (HHGM) in this final rule. DATES: These regulations are effective on January 1, 2018. FOR FURTHER INFORMATION CONTACT: For general information about the Home Health Prospective Payment System (HH PPS), please send your inquiry via email to: For information about the Home Health Value-Based Purchasing (HHVBP) Model, please send your inquiry via email to: Contact Joan Proctor, (410) 786 0949 for information about the Home Health Quality Reporting Program (HH QRP).

4 SUPPLEMENTARY INFORMATION: Wage index addenda will be available only through the internet on the CMS Web site at: Medicare-Fee-for-Service-Payment/ Table of Contents I. Executive Summary A. Purpose B. Summary of the Major Provisions C. Summary of Costs and Benefits II. Background A. Statutory Background B. Current System for Payment of Home Health Services C. Updates to the Home Health Prospective Payment System D. Report to Congress: Home Health Study on Access to Care for Vulnerable Patient Populations and Subsequent Research and Analyses III.

5 Provisions of the Proposed Rule: Payment Under the Home Health Prospective Payment System (HH PPS) and Responses to Comments A. Monitoring for Potential Impacts Affordable Care Act Rebasing Adjustments B. CY 2018 HH PPS Case-Mix Weights C. CY 2018 Home Health Payment Rate Update D. Payments for High-Cost Outliers Under the HH PPS E. Proposed Implementation of the Home Health Groupings Model (HHGM) for CY 2019 IV. Provisions of the Home Health Value- Based Purchasing (HHVBP) Model and Responses to Comments A.

6 Background B. Quality Measures C. Quality Measures for Future Consideration V. Updates to the Home Health Care Quality Reporting Program (HH QRP) A. Background and Statutory Authority B. General Considerations Used for the Selection of Quality Measures for the HH QRP C. Accounting for Social Risk Factors in the HH QRP D. Removal From OASIS E. Collection of Standardized Patient Assessment Data Under the HH QRP F. HH QRP Quality Measures Beginning With the CY 2020 HH QRP G. HH QRP Quality Measures and Measure Concepts Under Consideration for Future Years H.

7 Standardized Patient Assessment Data I. Form, Manner, and Timing of Data Submission Under the HH QRP J. Other Provisions for the CY 2019 HH QRP and Subsequent Years K. Policies Regarding Public Display of Quality Measure Data for the HH QRP L. Mechanism for Providing Confidential Feedback Reports to HHAs M. Home Health Care CAHPS Survey (HHCAHPS) VI. Collection of Information Requirements A. Statutory Requirement for Solicitation of Comments B. Collection of Information Requirements for the HH QRP C. Submission of PRA-Related Comments VII.

8 Regulatory Impact Analysis A. Statement of Need B. Overall Impact C. Detailed Economic Analysis D. Accounting Statement and Table E. Reducing Regulation and Controlling Regulatory Costs F. Conclusion VIII. Federalism Analysis Regulation Text Acronyms In addition, because of the many terms to which we refer by abbreviation in this final rule, we are listing these abbreviations and their corresponding terms in alphabetical order below: ACH LOS Acute Care Hospital Length of Stay ADL Activities of Daily Living AM PAC Activity Measure for Post-Acute Care APR DRG All-Patient Refined Diagnosis- Related Group APU Annual Payment Update ASPE Assistant Secretary for Planning and Evaluation BBA Balanced Budget Act of 1997, Public Law 105 33 BBRA Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, (Pub.)

9 L. 106 113) BIMS Brief Interview for Mental Status BLS Bureau of Labor Statistics CAD Coronary Artery Disease CAH Critical Access Hospital CAM Confusion Assessment Method CARE Continuity Assessment Record and Evaluation CASPER Certification and Survey Provider Enhanced Reports CBSA Core-Based Statistical Area CCN CMS Certification Number CHF Congestive Heart Failure CMI Case-Mix Index CMP Civil Money Penalty CMS Centers for Medicare & Medicaid Services CoPs Conditions

10 Of Participation COPD Chronic Obstructive Pulmonary Disease CVD Cardiovascular Disease CY Calendar Year DM Diabetes Mellitus DRA Deficit Reduction Act of 2005, Public Law 109 171, enacted February 8, 2006 DRG Diagnosis-Related Group DTI Deep Tissue Injury EOC End of Care FDL Fixed Dollar Loss FI Fiscal Intermediaries FR Federal Register FY Fiscal Year HAVEN Home Assessment Validation and Entry System HCC Hierarchical Condition Categories HCIS Health Care Information System HH Home Health HHA Home Health Agency VerDate Sep<11>2014 20:38 Nov 06, 2017 Jkt 244001 PO 00000 Frm 00002 Fmt 4701 Sfmt 4700 E.