Home Health Agency Final Rule for 2024

The United States Centers for Medicare & Medicaid Services (“CMS”) recently issued its final rule (88 FR 77676) updating Medicare payment policies and rates for Home Health Agencies (“HHAs”) in calendar year (“CY”) 2024.

Home health providers will receive an aggregate 0.8%, or a $140 million increase in Medicare reimbursements from CY 2023. Notably, the increase reflects the effects of a behavioral adjustment decrease that will cut payments by an estimated 2.6%. CMS split the permanent adjustment in half due to concerns over how such a large decrease would affect providers. CMS stated it will account for the remaining permanent adjustment in future rulemaking.

CMS is also finalizing a permanent prospective negative adjustment to the CY 2024 home health 30-day period payment rate to account for increases in aggregate expenditures in future years.

Additionally, the final rule includes a 3.1% market basket increase in national hospice payments and a 36-month rule for HHAs and hospice providers. The rule forbids any change in majority ownership of an HHA or hospice provider by sale for the 36 months following initial Medicare enrollment or the most recent change in majority ownership. The rule also includes a number of provisions to better identify poor-performing hospices.

Finally, CMS will adopt a 2021-based home health market basket with proposed changes to the cost weights and price proxies.

A fact sheet for the CMS final rule may be accessed here.

End-Stage Renal Disease Final Rule

CMS issued the final rule (88 FR 76344) increasing payments to end-stage renal disease (“ESRD”) facilities for calendar year (“CY”) 2024. The ESRD prospective payment system (“PPS”) final rule also updates other payment adjustments and includes new reporting requirements and other policies for renal dialysis services for Medicare beneficiaries.

The final rule increases the ESRD PPS base payment rate of $265.57 by $5.45 to $271.02, increasing overall Medicare payments to ESRD facilities by 2.1%. The dialysis payment for patients with acute kidney injury will also increase to $271.02.

CMS is finalizing a payment adjustment to increase rates for new renal dialysis drugs and biological products after the Transitional Drug Add-on Payment Adjustment (“TDAPA”) period ends. During the two-year TDAPA period, Medicare adjusts payments for certain drugs and biologicals to offset costs and promote competition between other products in the ESRD PPS. This new add-on payment adjustment will last for three years after the TDAPA period ends and will support Medicare ESRD beneficiaries’ continued access to new renal dialysis treatments.

Beginning in 2025, the final rule will require ESRD facilities to report “time on machine” data, or the number of minutes a patient spends receiving in-center hemodialysis treatment, to measure patient-level resource usage.

CMS is also finalizing a transitional pediatric ESRD add-on payment adjustment of 30% per treatment amount to address concerns over equal access for pediatric beneficiaries. This payment will begin in 2024 and extend throughout 2025 and 2026.

A fact sheet for the CMS final rule may be accessed here.