IHA Daily Briefing: July 3

Tuesday, July 3, 2018

CMS Issues CY 2019 Medicare Home Health Payment Rule
CMS Reports on Health Insurance Marketplaces/Exchanges

CMS Issues CY 2019 Medicare Home Health Payment Rule
Yesterday, the Centers for Medicare & Medicaid Services (CMS) published a display version of its calendar year (CY) 2019 Medicare proposed rule addressing changes in Medicare payments for Home Health services. Highlights of the proposed rule include:

  • An increase in the CY 2019 standardized rates of 2.1 percent, when compared to the final CY 2018 rates. This percentage is comprised of a market basket increase of 2.1 percent, a 0.1 percent increase attributed to the change in the outlier payment threshold and a 0.1 percent decrease resulting from the change in the rural home health agency add-on payment methodology. Agencies that do not report quality measures to CMS are subject to a 2 percent reduction to the market basket increase;
  • A change in the methodology for computing the Medicare add-on payment for rural home health agencies, as legislated by the Bipartisan Budget Act of 2018. Beginning in CY 2019 and ending in CY 2022, CMS will classify all rural counties into one of three categories: high home health utilization, low population density and all others. The add-on payments will vary based on how an agency’s particular county is classified. For CY 2019, the proposed payment add-ons are:  1.5 percent for high utilization categories; 4.0 percent for low population and 3.0 percent for all others. The classification of rural Illinois counties can be found on the CMS website;
  • Changes to the Home Health Value-Based Purchasing program;
  • The implementation of a new Patient-Driven Groupings Model (PDGM) for Medicare home health payments, in accordance with the Bipartisan Budget Act of 2018. The PDGM, which would be implemented Jan. 1, 2020, replaces the current 60-day episodic payment for care with a 30-day episode, focused more on patient needs while reducing the administrative burden on home health agencies; and
  • A Request for Information (RFI) by CMS from home health industry stakeholders on the need to revise safety standards applied in the electronic exchange of healthcare information among providers.

See a CMS press release and fact sheet for more details on the rule.

The proposed rule is scheduled to be published in the Federal Register on July 12. Comments to CMS are due no later than Aug. 31.

CMS Reports on Health Insurance Marketplaces/Exchanges
Yesterday, the Centers for Medicare & Medicaid Services (CMS) released three reports on the current condition of the Federal and State-based Exchanges and state individual health insurance markets. According to CMS, collectively, these reports show that state markets are increasingly failing to cover people who do not qualify for federal subsidies even as the Exchanges remain relatively stable.

The three reports released include the Early 2018 Effectuated Enrollment Snapshot, Exchanges Trends Report, and new for this year, Trends in Subsidized and Unsubsidized Enrollment. The reports include data on effectuated Exchange enrollment for 2017 and 2018, overall trends on the operational and programmatic performance of the Exchange, and trends in subsidized and unsubsidized individual market enrollment from 2014 to 2017. These data provide a number of insights on how well state individual health insurance markets and Exchanges are serving the American consumer.

As of March 15, 2018, 10.6 million individuals had effectuated coverage—meaning that they selected a plan, paid their first month’s premium, if applicable, and had coverage in February 2018—through the Federal and State-Based Exchanges. According to CMS, the total number of individuals with February 2018 coverage is about 9 percent lower than the number of individuals (11.8 million) who made plan selections during the 2018 Open Enrollment period, as reported in the 2018 Open Enrollment Final Report. The number of individuals with effectuated coverage for February 2018 is approximately 3 percent higher than February 2017 effectuated enrollment of 10.3 million individuals, as of March 15, 2017.

As of February 2018, Illinois had nearly 305,000 people with effectuated enrollment, with 263,000 receiving an advance premium tax credit and nearly 136,000 enrolled in a cost sharing reduction.