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CY 2016 Home Health Prospective Payment System Rate Update

Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements

Final

Proposed rule published July 10, 2015. Comments closed September 4, 2015. Final rule published November 5, 2015, effective January 1, 2016.

Docket
CMS-1625
RIN
0938-AS46
Documents
4 documents, July 10, 2015 to November 5, 2015
Amends
42 CFR parts 409, 424, 484

Documents

Oldest first

  1. July 10, 2015

    Comments closed

    Proposed rule, CMS-1625-P, 80 FR 39840, 75 pages

    Comments closed September 4, 2015.

    CMS's summary

    “This proposed rule would update Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60- day episode payment rates, the national per-visit rates, and the non- routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2016. As required by the Affordable Care Act, this proposed rule implements the third year of the four-year phase-in of the rebasing adjustments to the HH PPS payment rates. This proposed rule provides information on our efforts to monitor the potential impacts of the rebasing adjustments. This proposed rule also proposes: reductions to the national, standardized 60-day episode payment rate in CY 2016 and CY 2017 of 1.72 percent in each year to account for estimated case-mix growth unrelated to increases in patient acuity (nominal case-mix growth) between CY 2012 and CY 2014; a HH value-based purchasing (HHVBP) model to be implemented beginning January 1, 2016 in which all Medicare-certified HHAs in selected states will be required to participate; changes to the home health quality reporting program requirements; and minor technical regulations text changes. Finally, this proposed rule would update the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking and provide an update on the Report to Congress regarding the home health (HH) study.”

    Dates

    “To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on September 4, 2015.”
  2. August 4, 2015

    Correction

    Correction, CMS-1625-CN, 80 FR 46215, 4 pages

    Comments closed September 4, 2015. 119 comments posted on Regulations.gov as of October 9, 2026.

    CMS's summary

    “This document corrects technical errors in the proposed rule that appeared in the July 10, 2015 Federal Register entitled "Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements."”

    Dates

    “Comments on the proposed rule published on July 10, 2015 (80 FR 39839), continue to be accepted until September 4, 2015.”
  3. August 18, 2015

    Correction

    Correction, CMS-1625-CN2, 80 FR 49973, 2 pages

    Comments closed September 4, 2015. 119 comments posted on Regulations.gov as of October 9, 2026.

    CMS's summary

    “This document corrects technical errors in the proposed rule that appeared in the July 10, 2015 Federal Register entitled "Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value- Based Purchasing Model; and Home Health Quality Reporting Requirements."”

    Dates

    “The comment due date for the proposed rule published in the Federal Register on July 10, 2015 (80 FR 39839) remains September 4, 2015.”
  4. November 5, 2015

    Final rule

    Final rule, CMS-1625-F, 80 FR 68624, 96 pages

    Effective January 1, 2016.

    CMS's summary

    “This final rule will update Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non- routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2016. As required by the Affordable Care Act, this rule implements the 3rd year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking and provides a clarification regarding the use of the "initial encounter" seventh character applicable to certain ICD-10-CM code categories. This final rule will also finalize reductions to the national, standardized 60-day episode payment rate in CY 2016, CY 2017, and CY 2018 of 0.97 percent in each year to account for estimated case-mix growth unrelated to increases in patient acuity (nominal case-mix growth) between CY 2012 and CY 2014. In addition, this rule implements a HH value-based purchasing (HHVBP) model, beginning January 1, 2016, in which all Medicare-certified HHAs in selected states will be required to participate. Finally, this rule finalizes minor changes to the home health quality reporting program and minor technical regulations text changes.”

    Dates

    “Effective Date: These regulations are effective on January 1, 2016.”

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