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L&M to develop and assess HH PPS reform options to ensure access to care and adequate payment for vulnerable populations

Due to concerns over decreased access to Medicare home health services for some populations, the Affordable Care Act mandates that CMS complete a study of the Home Health Prospective Payment System (HH PPS). The study aims to analyze payment reform options to minimize program vulnerabilities, improve system-wide reimbursement and payment accuracy, and ensure access to home health services for low-income beneficiaries, beneficiaries living in medically underserved areas, and beneficiaries with high levels of clinical severity.

CMS has contracted with L&M to execute the study with the following research objectives:

  • Analyze patient characteristics and payment system incentives to ensure adequate reimbursement for vulnerable populations
  • Identify methods to discourage case-mix growth unrelated to actual changes in patient characteristics
  • Analyze utilization, case-mix, and outcomes to ensure that the provision of therapy is appropriately incentivized
  • Review methods to improve the outlier payment system so that it adequately reimburses cases that truly require more resources than were captured in the case-mix weights
  • Determine if adjustments are needed for patients entering home health through the community versus a post-acute stay
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