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The Centers for Medicare and Medicaid Services (CMS) announced rate increases for home health agencies (HHAs) for calendar year 2007. The 3.3% increase is the estimated 2007 home health market basket inflationary increase. The increase applies to the base rate for each 60-day episode. Under the home health prospective payment system (PPS), rates are higher for patients with greater care needs. The base episode rate for 2007 is $2,339 (before case-mix adjustment). The case-mix adjustment for each 60-day episode is determined by a comprehensive patient assessment tool, the OASIS (Outcome Assessment Information Set). Rural HHAs will receive a 5% increase for 2007 episodes that began in 2006, as required by the Deficit Reduction Act (DRA) that created the rural add-on for 2006. Added to the episodic rate is a "high-therapy case-mix adjustment" of approximately $2,500 if a patient receives at least ten therapy visits.
If there are less than five total home health visits in an episode, payment is made on a per visit basis, by discipline. The speech-language pathology rate is 7.9% above the physical therapy and occupational therapy rates; $127.39 compared with $117.23 for physical therapists and $118.02 for occupational therapists (geographically adjusted). The final regulation can be found at http://www.cms.hhs.gov/HomeHealthPPS/downloads/CMS1304Fdisplay.pdf (PDF format).
As required by the DRA, home health agencies that do not submit data on ten quality measures in the OASIS will be penalized by a payment reduction of two percentage points in the annual market basket update. Thus, instead of a 3.3% increase there would be a 1.3% increase for 2007. The OASIS quality measures that CMS believes are a measure of home health excellence are not related to communication or swallowing services. CMS plans to identify processes of care that lead to improvements for certain patient populations. These processes are currently in the very early stages of development. For further information, please contact Mark Kander, ASHA's Director of Health Care Regulatory Analysis, via e-mail at mkander@asha.org or by phone at 800-498-2071, ext. 4139.
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