CMS introduces proposed rule for CY 2025 home health PPS, maintains budget neutrality adjustments

The Centers for Medicare & Medicaid Services issued its calendar year 2025 proposed rule for the home health prospective payment system on June 26. The proposed rule includes a 3.0% market basket update, reduced by a 0.5% productivity adjustment. However, CMS is also proposing to reduce the base payment rate by 4.1% due to the Patient-driven Groupings Model, which would decrease total payments by 3.6%.

The proposed rule would result in an estimated $280 million reduction in net home health payments, or -1.7%, in calendar year 2025 compared to the current year. The American Hospital Association (AHA) has expressed concerns about these adjustments, noting that they come on top of previous years of similar downward adjustments.

CMS is also proposing to adjust the fixed-dollar loss amount for high-cost outliers, which would further reduce payments by an additional 0.6%, or $100 million. In addition, CMS is updating the HHA Conditions of Participation to include a new standard that would require HHAs to have a policy for accepting patients to service.

While CMS is not proposing to adopt or remove any quality measures from the HH Quality Reporting Program, the agency is proposing to modify patient assessment items related to health-related social needs. HHAs would need to collect and report specific data elements related to living situation, food, and utilities starting in CY 2027.

Another change proposed by CMS is the revision of infection prevention and control requirements for long-term care facilities. This would extend reporting to the Centers for Disease Control and Prevention of certain COVID-19 data elements and also require reporting of data related to influenza and RSV starting Jan. 1, 2025.

CMS is accepting comments on the proposed rule until August 26. AHA members will receive a Special Bulletin with additional details on the rule in the near future.