Medicare Home Health Agency Rules for 2013

December 20, 2012

For 2013, the Centers for Medicare and Medicaid Services (CMS) has revised the home health therapy reassessment schedule, updated payment rates, and implemented mandated unannounced survey visits.

Therapy Reassessment Schedule
For 2013, the regulation is revised to state: reassessment visits are completed during the 11th, 12th, or 13th Medicare-covered therapy visit for the required 13th visit reassessment...and the 17th, 18th, or 19th visit for the required 19th visit reassessment.

Payments Per Visit
If there are less than five total home health visits in an episode, the episode payment is substituted by a fixed payment per visit based on historic per-visit costs by discipline. The 2013 per-visit rates—known as the low-utilization payment adjustments (LUPA)—are $135.86 for speech-language pathologists compared with $125.03 for physical therapists and $125.88 for occupational therapists (geographically adjusted). This represents a 1.3% increase for each discipline.

Base Payment Rate Per Episode
The home health agency (HHA) prospective payment system (PPS) base fee per episode in 2013 will remain virtually unchanged, despite inflationary and wage index increases. This is because of imposed reductions that continue to repay Medicare due to widespread inaccurate patient health status coding between 2000 and 2008 by HHAs.

Unannounced Survey Visits
Visits to determine whether the care meets the assessed needs of individual patients (performed with the consent of the patient or legal representative) by state health departments or other state agencies will now always be unannounced. An HHA is surveyed at least every 36 months; more frequent surveys occur if available information indicates higher risks of quality of care.

Background: HHA services are performed by nurses, home health aides, social workers, and SLP/PT/OT. Although SLP visits are less than 1% of all visits, total SLP visits in 2011 were over one million.

Resources: For more information, please review the announcement in the Federal Register [PDF, 5.7MB] or contact Mark Kander, ASHA's director of health care regulatory analysis, by e-mail at

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