In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Based on IGI's third-quarter 2020 forecast (with historical data through second-quarter 2020) of the HHA market basket percentage increase and IGI's September 2020 macroeconomic forecast of MFP, the home health payment update percentage for CY 2021 will be 2.0 percent (2.3 percent HHA market basket percentage increase less 0.3 percentage point MFP adjustment) for HHAs that submit the required quality data and 0.0 percent (2.0 percent minus 2.0 percentage points) for HHAs that do not submit quality data as required by the Secretary. Services that are covered under the home infusion therapy benefit as outlined at 486.525 of this chapter, including any home infusion therapy services furnished to a Medicare beneficiary that is under a home health plan of care, are excluded from coverage under the Medicare home health benefit. These 432 HHRGs represent the different payment groups based on five main case-mix variables under the PDGM, as shown in Figure 1, and subsequently described in more detail throughout this section. Information about this document as published in the Federal Register. To illustrate, suppose a supplier has a single practice location in State X. 1,011 home health agencies participated in the study. For certain cases that exceed a specific cost threshold, an outlier adjustment may also be available. The home infusion therapy supplier does not meet all of the requirements for enrollment outlined in 424.68 and in part 424, subpart P of this chapter; or. The authority citation for part 414 continues to read as follows: Authority: In the CY 2020 HH PPS final rule with comment period (84 FR 60478), we finalized that the payment amounts per category, for an infusion drug administration calendar day under the permanent benefit, be in accordance with the six PFS infusion CPT codes and units for such codes, as described in section 1834(u)(7)(D) of the Act. Under section 1895(b)(4)(C) of the Act, the wage adjustment factors used by the Secretary may be the factors used under section 1886(d)(3)(E) of the Act. In a medical setting, nurses must convey and promote information about medicines. Many commenters supported the amendment to 409.43(a), allowing the use of telecommunications technology to be included as part of the home health plan of care during both the COVID-19 PHE, as well as beyond this time period, under the Medicare home health benefit. We stated that, as there is no separate Medicare Part B DME payment for the professional services associated with the administration of certain home infusion drugs covered as supplies necessary for the effective use of external infusion pumps, we consider the home infusion therapy services benefit to be a separate payment in addition to the existing payment for the DME equipment, accessories, and supplies (including the home infusion drug) made under the DME benefit. 14. We also proposed to allow HHAs to continue to report the costs of telehealth/telemedicine as allowable administrative costs on line 5 of the home health agency cost report. As discussed previously, overall, we believe that adopting the revised OMB delineations for CY 2021 results in HH PPS wage index values being more representative of the actual costs of labor in a given area. We received several comments on the HH QRP. In the CY 2015 HH PPS final rule (79 FR 66085 through 66087), we adopted OMB's area delineations using a 1-year transition. You can choose to study to become a registered nurse right away. 11. Why do people leave their jobs? In response to the comment regarding the new OMB delineations and the potential effect on the rural add-on payment, section 50208(a)(1)(D) of the BBA of 2018 (revising section 421 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. Effective January 1, 2021 there are changes to the office/outpatient E/M visit code set (CPT codes Start Printed Page 7034099201 through 99215) used to calculate the initial and subsequent visit payment amounts for home infusion. New Documents "$bDhKaa,/e2) jc[IoU? In the CY 2019 HH PPS final rule with comment period (83 FR 56492), we finalized our policy that the LUPA thresholds for each PDGM payment group would be reevaluated every year based on the most current utilization data available at the time of rulemaking. We received two timely public comments on our proposed change to remove the OASIS requirement at 484.45(c)(2). Our mission is to Empower, Unite, and Advance every nurse, student, and educator. Because we believe that using the new OMB delineations would create a more accurate payment adjustment for differences in area wage levels we proposed to include a cap on the overall decrease in a geographic area's wage index value. This process helps to prevent unqualified and potentially fraudulent individuals and entities from being able to enter and inappropriately bill Medicare. The third column shows the payment effects of updating to the CY 2021 wage index. Section III.E. Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services, section 50.2Determining Self-Administration of Drug or Biological. It is not an official legal edition of the Federal We note that in response to the CY 2021 HH PPS proposed rule, we received approximately 162 timely pieces of correspondence from the Start Printed Page 70301public, including from home health agencies, national and state provider associations, patient and other advocacy organizations, nurses, and other healthcare professionals. Services for the provision of drugs and biologicals not covered under this definition may continue to be provided under the Medicare home health benefit, and paid under the home health prospective payment system. Therefore, although home infusion therapy services related to the administration of Hizentra are covered under the temporary transitional payment, because it is currently on a SAD exclusion list, services related to the administration of this biological are not covered under the benefit in 2021; however, if it is removed from all the SAD lists, it could be added to the home infusion drugs list in the future. Through the Local Coverage Determination (LCD) for External Infusion Pumps (L33794), the DME Medicare administrative contractors (MACs) specify the details of which infusion drugs are covered with these pumps. While we did not make any proposals regarding policies finalized in the CY 2020 HH PPS final rule with comment period as they relate to the implementation of the permanent home infusion therapy services in CY 2021, we did receive comments making suggestions to change certain aspects of the finalized policies. Home health remains a multidisciplinary benefit and payment is bundled to cover all necessary home health services identified on the individualized home health plan of care. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of less than $7.5 million to $38.5 million in any one year. Section IV.C. ), 1/7/2021 and after = Day 6 and beyond (A no-pay RAP submitted on and after this date will trigger the penalty.). L. 114-255) beginning January 1, 2021. . Requiring that services furnished through telecommunications technology be incorporated into the plan of care, rather than simply requiring a physician's or allowed practitioner's order, acknowledges that each plan of care is unique to the individual. Under the new OMB delineations (based upon the 2010 decennial Census data), a total of 47 counties (and county equivalents) that are currently designated rural and are considered urban beginning in CY 2021. The quality, utility, and clarity of the information to be collected. As discussed previously the most recent OMB Bulletin (No. Local Coverage Determination (LCD): External Infusion Pumps (L33794). We did not receive any comments on the LUPA add-on factors. Average actual self-pay (private pay) home health charges have been rounded to the nearest dollar and reflect charges as of January 1, 2022. Finally, with the influx of education and new technologies Nurses must keep abreast of current health trends. but a claim, Broadly speaking, a nurse is a highly skilled person who is responsible for the holistic care and well-being of patients. To enroll in the Medicare program as a home infusion therapy supplier, a home infusion therapy supplier must meet all of the following requirements: (1)(i) Fully complete and submit the Form CMS-855B application (or its electronic or successor application) to its applicable Medicare contractor. Therefore, we are not providing any estimated impacts. Commenters included an industry association and an accreditation organization. Our members represent more than 60 professional nursing specialties. By dividing the total payments for non-LUPA 30-day periods using the CY 2021 wage index by the total payments for non-LUPA 30-day periods using the CY 2020 wage index, we obtain a wage index budget neutrality factor of 0.9999. We note that in past years, a case-mix budget neutrality factor was annually applied to the HH PPS base rates to account for the change between the previous year's case-mix weights and the newly recalibrated case-mix weights. Second, section 1861(iii)(3)(D)(i)(IV) of the Act permits the Secretary to establish requirements for qualified home infusion therapy suppliers that the Secretary determines appropriate. I think they should be paying you much more than that. The 12 clinical groups are listed and described in Table 2. Additionally, a few commenters requested to use the proposed 2.7 percent increase as a floor and urged CMS to not make any downward adjustments to the market basket in the final rule. Specializes in Home Health. Consistent with the definition of home infusion drug, the home infusion therapy services will be covered under payment category 2 for these two subcutaneously infused drugs. Home Health Visit Services Fee Schedule 2021 CODE MOD 1 MOD 2 DESCRIPTION OF SERVICE MAXIMUM . Required fields are marked *. Therefore, in accordance with section 1834(u)(7)(F) of the Act, we clarified that this meant that in addition to other DME suppliers, existing DME suppliers that were enrolled in Medicare as pharmacies that provided external infusion pumps and external infusion pump supplies, who complied with Medicare's DME Supplier and Quality Standards, and maintained all pharmacy licensure requirements in the State in which the applicable infusion drugs were administered, could be considered eligible home infusion suppliers for purpose of the temporary home infusion therapy benefit. End users do not act for or on behalf of the CMS. documents in the last year, 20 The ADA is a third-party beneficiary to this Agreement. A commenter recommended that CMS expedite development of new measures to address pain management after the recent removal of the Improvement in Pain Interfering with Activity quality measure from the HH QRP. Section 424.520 outlines the effective date of billing privileges for certain provider and supplier types that are eligible to enroll in Medicare. This transition allows the effects of our adoption of the revised CBSA delineations to be phased in over 2 years, where the estimated reduction in a geographic area's wage index would be capped at 5 percent in CY 2021 (that is, no cap would be applied to the reduction in the wage index for the second year (CY 2022)). If you want to be a registered nurse you will need more than two years of education and training, however, the good news is that there are more options in terms of accreditation requirements and which institutions you can take. In accordance with 486.525, the required items and services covered under the home infusion therapy services benefit are as follows: We also noted that the CY 2019 HH PPS proposed rule described the professional and nursing services, as well as the training, education, and monitoring services included in the payment to a qualified home infusion therapy supplier for the provision of home infusion drugs (83 FR 32467). While we solicited comments on the approach in estimating the number of entities which would review the proposed rule and the assumption of how much of the rule reviewers would read, we did not receive any comments. Local Coverage Determination (LCD): External Infusion Pumps (L33794). Infusion drugs, equipment, supplies, and administration are all covered by Medicare in the inpatient hospital, SNFs, HOPDs, and physicians' offices. We believed this was a reasonable barometer with which to establish estimates (strictly for purposes of the final rule) of the fee amounts in the first 3 CYs of this rule (that is, 2021, 2022, and 2023). A commenter suggested the redefinition of the New York-Jersey City-White Plains, NY-NJ CBSA will cause major Medicare reimbursement reductions across many hospitals and other providers, including Home Health Agencies, in New York and New Jersey. On April 10, 2018 OMB issued OMB Bulletin No. Section 1895(b)(3)(A)(iv) of the Act further requires the Secretary to provide a description of the behavior assumptions made in notice and comment rulemaking. We apply the appropriate wage index value to the labor portion of the HH PPS rates based on the site of service for the beneficiary (defined by section 1861(m) of the Act as the beneficiary's place of residence). 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