This past April, representatives from the Centers for Medicare and Medicaid Services (CMS) provided updates to the National Association for Home Care attendees at the policy conference in Washington, DC.

Pending Regulations Regarding Payment and Pay for Performance

Laurence Wilson, director of CMS's Chronic Care Policy Group, addressed pending regulations that will impact payment to agencies. Current legislation will limit home health payment increases to the market basket update minus 0.8%. Mr. Wilson predicted that the 2006 update will be approximately 2.3% to 2.4%.

There is also additional review of the current prospective payment system (PPS) that includes case-mix adjustments, as a result of research now under way examining the entire PPS system. This research, being conducted by Abt Associates, has targeted several issues and is likely to bring about policy changes in areas such as:

* Medical supply costs;

* Payment rates for subsequent episodes for long-stay patients; and

* Replacement of the therapy threshold with indirect indicators of cost.

Mr. Wilson also discussed the possibility of a Pay-for-Performance system sometime in the future, but reminded everyone that this will require additional research and Congressional approval.

Survey and Certification

Representatives responsible for CMS survey-and-certification policy from the agency's Division of Continuous Care Providers summed up policy letters that were sent to state survey agencies over the past year. A final regulation for reporting Outcome and Assessment Information Set (OASIS) data as a condition of participation will be published in the fall, the representatives reported.

This final rule will address comments on the OASIS reporting interim final rule, which serves as the basis for current practices, and is expected to include "a few minor revisions" to reporting requirements. Home health agencies will be allotted a 6-month time to implement required changes.

The survey data presented included a reported total number of home health agencies last year of 7,756 and some 141 home health agency closures (of which 123 were voluntary). Of the 3,346 surveys of home health agencies conducted last year, 10% were instituted as a result of complaints.

The top 10 deficiencies cited last year were

1. Plan of care was not established or reviewed;

2. Plan of care did not cover diagnoses, services, and/or visits;

3. Clinical record was incomplete and failed to include findings;

4. Assessments did not include medication review;

5. Clinicians did not alert the physician to significant changes in the patient's status;

6. Drugs and prescriptions were not administered as ordered;

7. Aide supervisory visits were not conducted every 2 weeks;

8. No coordination of patient services;

9. Clinical record did not establish coordination of services; and

10. Registered nurse did not regularly re-evaluate nursing needs.

Future CMS initiatives are anticipated to address transitioning the survey process toward a patient-focused, data-driven process that is more effective and efficient. The goal of the change is to detect problematic care before an onsite survey, differentiating between those agencies that have a higher likelihood of termination risk from those that are satisfactory performers. In addition, CMS is seeking to determine ways to improve consistency in surveyor citations across the country.

Home care providers are encouraged to keep an eye on the regulatory alerts and letters that are periodically sent to agencies. Agencies need to provide comments as requested to provide CMS with reality-based feedback.