Updated on 06/20/2022

On Friday June 17, CMS released the unpublished version of the 2023 Home Health Payment Proposed Rule.  This rule contains significant changes that will affect agencies and it is strongly suggested that agencies comment on the rule.  Three main areas of significance are mention below.

  1. A net NEGATIVE payment adjustment is proposed.  CMS is providing an annual + 2.9% inflation adjustment, but is initiating a -7.68% “budget neutrality behavioral adjustment”.  This will result in home health agency 30 day claim amount decreasing by 4.78% from 2022 rates currently being paid.  Sequestration will further decrease this amount by -2%, resulting in a -6.78% total adjustment for all agencies in 2023.  This proposed net reduction in payment to agencies will be a traumatic hit to agencies who are already being impacted with the highest level of inflation for over 40 years and the highest gas prices ever witnessed.  Agencies may also take a financial hit from a possible pending recession.
  2. OASIS-E is becoming effective January 1, 2023, which by itself will impact agency clinicians, but the proposed rule, if approved, will expand OASIS to be collected on ALL patients.  Currently agencies are only required to collect the OASIS assessment on Medicare and Medicaid patients.  Some long term agencies will remember that when OASIS was first initiated, it required capturing OASIS on all patients, but was quickly changed to just Medicare and Medicaid patients.  Under the proposed rule, agencies will be required to collect a comprehensive OASIS assessment and submit to iQIES on ALL patients, regardless of whether the patient utilizes private insurance, such as HMO, Managed Care, or are private pay patients.  This additional OASIS data collection will not only impact the productivity of agencies clinical staff, but the OASIS data on all of these new patients will be used for the Home Health Quality Reporting Program and appear on Care Compare and your Start Rating.
  3. New G Codes are proposed for use on claims to document telehealth visits.  While NO payment will be provided for visits conducted by Telehealth, these visits will be required to appear on the 30 day claim.  Currently Telehealth visits can be completed by agencies, but cannot appear on the claim.  This could be a blessing as data will be collected by CMS on how many telehealth visits are being completed and thus a future payment change could include payment for these visits, but under this proposed rule, it is just an additional impact on the workload of your clinicians and billers to select the new G Codes and ensure visits appear on the claim.

Every proposed rule can, and should, be commented on by agency, staff members, patients and the entire public.  Comments are strongly encouraged, but MUST be received by 5 PM EST on August 16, 2022.  All comments are reviewed and publicly available.  Comments often have an effect on the final rule.

The final rule is will be published around the end of October/beginning of November and take effect January 1, 2023.

This proposed rule is scheduled to be officially published in the Federal Register on June 23, 2022.

Click here for details of the full proposed rule text and to make comments!