Proposed rule for 2021



Here are six things home care providers need to know about the proposed rule for 2021

A $540 million payment increase for home care providers was included in Medicare’s proposed rule setting home health payment rates and wage index for calendar year 2021, released by the Centers for Medicare and Medicaid Services (CMS) late last week. But what isn’t in the proposed rule has also caught the attention of home health agencies.


  • · No reimbursement is proposed for agencies who include telehealth visits as part of the overall Plan of Care for their patients, even though the rule would make permanent the telehealth changes enacted in response to the COVID-19 Public Health Emergency.

  • · No changes were made to the Patient-Driven Groupings Model, the new Medicare payment methodology implemented in 2020.

“Agencies were interested in whether CMS might make these telehealth changes permanent and possibly address reimbursement in the proposed rule,” said J’non Griffin, president and owner of Home Health Solutions, a nationwide consulting and outsourcing firm for home health, hospice and long-term care. “But CMS said technology still cannot substitute for in-person visits on the Plan of Care, and cannot be considered a visit for the purpose of patient eligibility or payment,” she said. The rule is expected to be posted to the Federal Register on June 30, and may be viewed as a PDF here. In addition to the payment update, it addresses home infusion therapy policies and updates the infusion therapy payment rate.

Here is a list of the 6 important things agencies need know about the proposed rule: 1. A 2.6 percent increase The payment rate update for calendar year 2021 is an estimated $540 million, or 2.6 percent. Additionally, the rule proposes to maintain the fixed-dollar loss ratio at 0.63, as finalized for CY 2020, and to place a 1-year cap on wage index decreases in excess of 5 percent, consistent with the policy being proposed for other Medicare payment systems. 2. Telehealth The rule proposes to make permanent telehealth changes enacted in response to the COVID-19 Public Health Emergency – but does not propose any direct payment to agencies for telehealth. Telecommunications will be allowed as long as it is related to the skilled services being furnished, as outlined in the Plan of Care, and tied to specific goals indicating how it will facilitate treatment outcomes. Agencies may continue to report telecommunications as allowable administrative expenses on the cost report. 3. Home infusion therapy Two things would change under the 2021 proposed rule. - Regulations text would be changed. Current wording excludes home infusion therapy services from coverage under the Medicare home health benefit. - The rule would also address enrollment policies for qualified home infusion therapy suppliers. 4. Test transmission of OASIS New agencies which do not yet have a CMS certification number would no longer be required to conduct test OASIS data transmissions to the CMS data system as part of the initial certification process

5. PDGM stays the same

There are no changes to the Patient-Driven Groupings Model, Medicare’s new payment methodology implemented in 2020.


6. A hint of things to come

CMS did provide another hint that it plans to make permanent more of the provider flexibilities given to home care providers under the March 30 interim rule enacting policy and regulatory revisions in response to the coronavirus pandemic.

“These proposed changes are one of the first flexibilities provided during the COVID-19 PHE that CMS is proposing to make a permanent part of the Medicare program,” CMS stated.

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