The Centers for Medicare and Medicaid Services (CMS) released the CY 2025 Medicare Home Health Final Rule on Friday November 1st. The overall economic impact related to the changes in payments under the HH PPS for CY 2025 is estimated to be $85 million (0.5 percent).
The $85 million increase in estimated payments for CY 2025 is the result of a combination of:
- A 2.7 percent ($460 million) increase in the home health payment update percentage
- An estimated 1.8 percent ($305 million) decrease tied to the permanent behavior assumption adjustment
- An estimated 0.4 percent ($70 million) FDL decrease
The 1.8 percent decrease related to the finalized behavior assumption adjustment affects all payments. A -1.975 percent BA adjustment was also finalized. However, this adjustment only applies to the national, standardized 30-Day period payments and does not impact payments for LUPAs.
Among other things, the rule:
- Discusses comments related to the monitoring and data analysis on PDGM utilization
- Discusses providers’ suggestions regarding the reassignment of specific ICD-10-CM diagnosis codes
- Finalizes a permanent adjustment of -1.975 percent (half of the proposed -3.95 percent)
- Finalizes updates to:
- LUPA thresholds
- Case-mix weights
- Functional impairment levels
- Comorbidity adjustment subgroups
- Wage index
- FDL ratio
- 30-Day period payment rate ($2,057.35)
- dNPWT Device payment rate
- Intravenous immune globulin (IVIG) items and services payment rate
- Finalizes a crosswalk for mapping the OASIS-D data elements to the equivalent OASIS-E data elements for use in the methodology to analyze the difference between assumed versus actual behavior change on estimated aggregate expenditures
- Finalizes the adoption of the most recent Office of Management and Budget’s Core Based Statistical Area (OMB CBSA) Delineations (from the 2020 Decennial Census) for the wage index
- Finalizes updates to the OT, PT, SLP, and SN LUPA add-on factors
- Finalizes the collection of four new items as standardized patient assessment data elements in the social determinants of health (SDOH) category
- Modifies one item (Transportation) collected as a standardized patient assessment data element in the SDOH category beginning with the CY 2027 Home Health Quality Reporting Program (HH QRP)
- Finalizes that all-payer data collection is to begin with the start of care OASIS data collection timepoint instead of the discharge timepoint for Non-Medicare/Non-Medicaid patients
- Summarizes comments received on future Home Health Value-Based Purchasing (HHVBP) performance measure concepts
- Finalizes a new standard that will require home health agencies to develop, implement, and maintain an acceptance-to-service policy that is applied consistently to each prospective patient referred for home health care
- Summarizes comments received on other factors that influence the patient referral and intake processes
- Finalizes the expansion of the definition of “new provider or supplier” (in regard to enhanced oversight and screening) to include providers and suppliers that are reactivating their Medicare enrollment and billing privileges
Each year, the Homecare Homebase team analyzes the Home Health Final Rule and updates our EHR system to adapt to new regulatory requirements. In addition, the HCHB Analytics team is working on updates to the PDGM Impact Model and will be sending out further communication detailing the changes and when customers can expect to receive the updated analysis.
HCHB is committed to helping agencies successfully navigate the complexities associated with regulatory and industry changes. Contact us if you have questions on how technology can help your team stay on top of compliance requirements.
Explore the final rule further with these resources
- Final rule (CMS-1803-F)
- Federal register
- Fact sheet
- Supporting files
