Update to the Prospective Payment System for Home Health Agencies for FY 2004
The Centers for Medicare & Medicaid Services (CMS) has directed Regional Home Health Intermediaries (RHHIs) to implement the FY2004 annual update for the home health prospective payment system (HH PPS). (WPS is not a RHHI). The home health PPS rates are the national 60-day episode and the national per visit amounts by discipline used to calculate the low utilization payment adjustment and the outlier payment. For FY 2004, CMS used the design and case mix methodology described in section III.G of the home health PPS July 3, 2000 final rule (65 FR 41192-41203). For FY 2004, CMS based the wage index on the wage index adjustment to the labor portion of the of the PPS rates on the most recent pre-floor and pre-reclassified hospital wage index at the time of publication of the home health PPS annual update notice. The labor adjustment to the PPS rates will continue to be based on the site of service of the beneficiary as set forth in the Code of Federal Regulations (CFR) at 42 CFR 484.220 and 484.230. This labor adjustment is applied to both per-episode and per-visit payment calculations.
The HH PPS annual update notice was published in the Federal Register on July 2, 2003.
National 60-day episode amounts updated by the Home Health Market Basket for FY 2004 prior to Case-Mix Adjustment and Wage adjustment based on the site of service the beneficiary or applicable payment adjustment.
| Total standardized Prospective payment amount per the 60-day episode for FY 2003 | Multiply by 1 plus the home health market Basket increase | Final updated 60-day episode rate for FY 2004. | |
| $2,159.39 | x1.033 | $2,230.65 | |
National per-visit amounts for LUPAs and outlier calculations updated by the home health market basket increase for FY 2004 prior to wage adjustment and based on the site of service for the beneficiary or the applicable payment adjustment.
| Home Health Discipline Type | Final standardized per-visit amounts per 60-day episode for FY 2003 for LUPAs | Multiply by 1 plus the finalized home health Market Basket. | Final per-visit payment amount in FY 2004. | |||
| Home Health Aide | $ 42.68 | x1.033 | $ 44.09 | |||
| Med Social Services | $ 151.11 | x1.033 | $ 156.10 | |||
| Occupational Therapy | $ 103.77 | x1.033 | $ 107.19 | |||
| Physical Therapy | $ 103.07 | x1.033 | $ 106.47 | |||
| Skilled Nursing | $ 94.27 | x1.033 | $ 97.38 | |||
| Speech Pathology | $ 112.00 | x1.033 | $ 115.70 | |||
The updated rates and wage indices may be obtained via the Government Printing Office web site at www.gpoaccess.gov/fr/advanced.html.
If you have any claims related questions, please contact your Regional Home Health Intermediary. For any PS&R related questions, contact the audit supervisor assigned to your facility.
Page Last Updated: Thursday, 18-Mar-2010 05:48:27 CDT
