American Speech-Language-Hearing Association

Medicare Releases Proposed Rules for Home Health Agencies (HHA)

(July 7, 2014)

The Centers for Medicare & Medicaid Services (CMS) released proposed rules and the wage index for calendar year 2015. Significant proposals relevant to speech-language pathologists include the following.

  • The standardized 60-day episode is increased by the proposed wage index to $2,922.76, up from FY2014 $2,869.27. The per-visit payment for episodes with four or fewer total visits for speech-language pathologists is $151.85, up from $143.88.
  • The therapy reassessment timeframe requirement will be changed from the current "close to 13th and 19th visits" to at least once every 14 calendar days. A qualified therapist from each discipline providing services must reassess the patient at least once every 14 calendar days regardless of the number of therapy visits provided. This change is meant to simplify the process.
  • The HHA provider qualification regulations will be updated to be consistent with the CMS statute and regulations, revising the SLP qualifications to an individual who has a master's or doctoral degree in speech-language pathology and who is licensed by the state. At this time all states require licensure for SLPs.

Other proposals include elimination of the need for a physician's separate narrative based on the required physician face-to-face visit, implementation of a benchmark of 70% compliance for quality reporting through OASIS, and the consideration of a demonstration value-based purchasing model.

ASHA will submit comments on the proposed rule, which are due early September.

Background

Home health services have been paid by a prospective payment system (PPS) since the enactment of the Balanced Budget Act of 1997. In order to ensure services are paid at a reasonable rate, the computation must include amounts based on the most recent audited cost report and adjusted to account for the effects of case mix and wage levels. Subsequent legislation has required quality reporting and physician face-to-face encounters. Final rules are anticipated in November and will take effect on January 1, 2015.

Resources

Medicare and Medicaid Programs: CY 2015 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Survey and Enforcement Requirements for Home Health Agencies

For more information, or to share your thoughts on the HHA proposed rules, please contact Lisa Satterfield, ASHA's director of health care regulatory advocacy, at lsatterfield@asha.org.


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