The Centers for Medicare & Medicaid Services (CMS) has issued the calendar year (CY) 2021 home health final rule on October 29, 2020. This final rule updates the home health prospective payment rate system rates and wage indexes. The rule implements changes regarding the use of telecommunications technology in providing services under the Medicare home health benefit in response to COVID-19. This rule also implements the permanent home infusion therapy services benefit and supplier enrollment requirements for CY 2021. The rule also finalizes the policy to align the Home Health Value-Based Purchasing (HHVBP) Model data submission requirements and the policy for granting exceptions to the new measures data reporting requirements.
Here are some highlights from the CY 2021 Home Health final rule:
- The case-mix weights for CY 2021 will be equal to the established case-mix weights for CY 2020.
- The Low Utilizations Payment Adjustment (LUPA) thresholds for CY 2021 will be the same as CY 2020.
- The behavior adjustment for CY 2021 will be the same as CY 2020.
- The CY 2021 national, standardized 30-day period payment amount will be $1,901.12.
- The LUPA rates increased by close to 2% for CY 2021.
- Requests for Anticipated Payment (RAPs) will be reimbursed at zero percent for all 30-day periods of care beginning on or after January 1, 2021.
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RAPs for 30-day periods of care beginning on or after January 1, 2021, must be submitted within 5 calendar days from the start of care. If the RAP submission is untimely, the home health agency will receive a reduction in payment amount equal to a one-thirtieth reduction for each day from the home health start of care date until the date the home health agency submits the RAP.
Example:
- January 1, 2021 = Day 0 (start of the 30-day period of care)
- January 6, 2021 = Day 5 (a RAP submitted on or before this date would be considered timely)
- January 7, 2021, and after = Day 6 and beyond (a RAP submitted on and after this date will trigger the penalty)
- Home health rural add-on percentages for CY 2021 are 2% for low population density provider, 0% for a high utilization provider, and 1% for all others.
You can find the link to the CY 2021 Home Health final rule here.
