September 25, 2020

Volume X, Number 269

September 25, 2020

Subscribe to Latest Legal News and Analysis

September 24, 2020

Subscribe to Latest Legal News and Analysis

September 23, 2020

Subscribe to Latest Legal News and Analysis

September 22, 2020

Subscribe to Latest Legal News and Analysis

CMS Takes Action to Modernize Medicare Home Health

New Medicare rules for home health services intended to encourage innovation will be implemented in 2020. The Centers for Medicare & Medicaid Services (CMS) finalized new rules for the Home Health Prospective Payment System (HHPPS) to allow for increased utilization of developing technologies that can provide more efficient and cost-effective care, implementation of new patient-driven compensation models, and allow the expansion of home infusion therapy.

According to CMS Administrator Seema Verma:

"This home health final rule focuses on patient needs and not on the volume of care. This rule also innovates and modernizes home health care by allowing remote patient monitoring. We are also proud to offer new home infusion therapy services. Using new technology and reducing unnecessary reporting measures for certifying physicians will result in an annual cost savings and provide Home Health Agencies (HHAs) and doctors what they need to give patients a personalized treatment plan that will result in better health outcomes."

Beginning in 2020, CMS will implement a new case-mix system called the Patient-Driven Groupings Model (PDGM). As described by Administrator Verma, the intent of the PDGM is to put the focus on patient needs rather than volume of care by heavily relying on specific patient characteristics to ensure home health services are being appropriately and accurately compensated.

For the first time, CMS will allow the cost of remote patient monitoring to be included by HHAs as an allowable cost on their Medicare cost report forms. CMS intends for this to promote the adoption and use of remote patient monitoring and other emerging technologies that lead to more effective care planning and data sharing amongst patients, providers, and caregivers.

The final rule will implement temporary transitional payments for home infusion therapy for 2019 and 2020, before the implementation becomes permanent in 2021. Providers should be aware that the final rule also establishes health and safety standards and requirements in order for the home infusion therapy services to qualify for the payments.

To streamline the delivery and administration of home health services, CMS is revoking the requirement for a provider to estimate how long home health services are needed when recertifying the need for continued home health care. CMS estimates that this will result in a reduction of $14.2 million in annual administrative costs for providers, which should facilitate more time for patient care.

©2020 von Briesen & Roper, s.cNational Law Review, Volume VIII, Number 339


About this Author

Stacy Gerber Ward, von Briesen Roper Law Firm, Milwaukee, Corporate and Health Care Law Attorney

Stacy Gerber Ward is a Shareholder and Leader of von Briesen’s Government Enforcement and Corporate Investigations Section. Stacy focuses on helping clients respond to government investigations and conduct internal investigations using her more than 14 years of experience serving as an Assistant United States Attorney for the Eastern District of Wisconsin and most recently as the Deputy Chief of the Civil Division. Stacy investigated and prosecuted individuals and corporations for civil health care fraud and other enforcement matters, including government enforcement...

Ryan Siehr, von Briesen Law Firm, Milwaukee, Corporate and Health Care Law Attorney

Ryan Siehr is an attorney in the Business Practice Group and serves as chair of the Health Information Privacy and Security Section. Ryan advises hospitals, multi-institutional health care systems, physician groups and specialty providers regarding a variety of transactional health care related matters, including acquisitions, physician agreements, and equipment and office space leasing arrangements. Ryan focuses on assisting these entities with HIPAA compliance, including developing policies and procedures and negotiating business associate, data use, trading partner, and other HIPAA related agreements. Ryan has significant experience with negotiating technology-related agreements in the health care industry, including software licensing, SaaS, ASP, maintenance, project implementation, master services, and development agreements.

Ryan also advises individuals, corporations, and partnerships regarding general corporate transactional matters, including the negotiation and documentation of stock and asset-based transactions involving the selection and formation of business entities, transition planning, including buy and sell agreements, rights of first refusal and restrictions on the sale of equity interests, and the negotiation and documentation of a variety of other contractual arrangements. Ryan also focuses on EAR and OFAC compliance for clients exporting goods out of the United States.

Ryan is a member of the State Bar of Wisconsin and the Milwaukee Bar Association.

414- 287-1595