Rates for the 2010 Medicare prospective payment system (PPS) for home health agencies have been released. The Centers for Medicare and Medicaid Services (CMS) issued the rates for the PPS, which reimburses home health care agencies (HHAs) prospectively for each 60-day "episode." The rate is based on a number of factors, including the need for and number of therapy visits during that 60-day period.
Reimbursement rates are calculated in part from information collected in the Outcome and Assessment Information Set (OASIS-C), which has been revised effective Jan. 1. This assessment collects data on the patient's health status including clinical condition, functional abilities, and service needs for each episode of care.
According to CMS, providers from all disciplines—including speech-language pathologists—may perform the OASIS assessment with assistance from Chapter 3 of the OASIS-C Guidance Manual (search "OASIS-C manual" at the Health and Human Services Web site). If the SLP is the first provider to visit a new patient, the SLP must perform the assessment, and may require training and consultation with other disciplines to report on certain items.
The base episode payment rate for 2010 is $2,270, a 1.9% increase. Payment for therapy services is included in the rate if at least six therapy visits are expected in the 60 days. The payment may vary depending on:
- Total number of therapy visits expected.
- Number of episodes.
- Patient's health status descriptors.
If fewer than five total home health visits are expected, a fixed payment per visit is established based on historic per-visit costs by discipline. The 2010 per-visit rate (known as the low utilization payment adjustment) is $134.27 for SLPs; $123.57 for physical therapists; and $124.40 for occupational therapists (geographically adjusted).
The HHA rule is published in the Nov. 10, 2009, Federal Register [PDF].