• CMS is posting Abt Associates' August 20, 2009 "Analysis of 2006-2007 Home Health Case-mix Change" report. This report is an update to the original April 2008 "Refinement of Medicare's Home Health Prospective Payment System: Final Report" and describes updates to the home health case-mix change analysis since the CY 2008 HH PPS Final Rule (CMS-1541-FC), up to and through the recently published CY 2010 proposed rule (CMS-1560-P). (posted 8/24/2009)

• An incorrect version of the wage index was inadvertently published at the Federal Register as part of CMS-1560-P (Publication Date: August 6, 2009). Consequently, the Federal Register reissued the Medicare Home Health Prospective Payment (HH PPS) rates for Calendar Year (CY) 2010 proposed rule (CMS-1560-P), with the correct wage index addenda.  It displayed on 8/12/09 and published on 8/13/09 at the Federal register. The comment period is not affected by this reissuance. (posted 8/13/2009)

•  CMS-1560-P (Publication Date:  August 6, 2009): The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update the Medicare Home Health Prospective Payment (HH PPS) rates for calendar year (CY) 2010.  This proposed rule continues with the previously promulgated 2.75 percent reduction to the HH PPS rates in CY 2010 (to account for the increase in case-mix not due to the underlying condition of the home health patient), proposes to update the HH PPS rates by a 2.2 percent home health market basket update, and as part of efforts to address potential fraud and abuse regarding outlier payments to home health agencies proposes to cap outlier payments at 10% of total HH PPS payments, update the fixed dollar loss ratio to 0.67, and target outlier payments to be no more than 2.5 percent of total HH PPS payments  (returning 2.5% back into the base rate).  CMS is also proposing to require the submission of OASIS as a condition for payment, as well as adding payment safeguards to improve the enrollment process, improve quality of care, and reduce fraud.  Finally, CMS is also proposing to implement a new version of OASIS, OASIS-C, on January 1, 2010.

• CMS is updating the HH PPS Grouper primarily due to changes in ICD-9-CM coding (effective October 1, 2009). CMS is providing an updated HH PPS Grouper Software Package (Version V2409). The materials provided include an updated version of the grouper logic (JAVA source code) and associated tables, an updated JAVA.dll software module and updated test cases to be used by those developing their own software to implement the grouper logic. The grouper has been restructured to use JAVA source code which is a change from previous versions. Accompanying the release is a Java .dll bridge which will enable users to call the grouper from C based applications. These enhancements will permit users to utilize the source code as a template when building their own programs ensuring greater consistency. A further break from previous releases is the process of ICD-9-CM validation. The HH PPS Grouper will require a valid ICD-9-CM code to obtain points when scoring assignments. This replaces the edits previously contained within the grouping logic. A table of valid ICD-9-CM codes for the corresponding periods is contained in the grouper release. The 2010 version of the Grouper Software package is available from the Home Health Case Mix Grouper Software Package web page in the Downloads section. (posted 7/30/2009)

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