CMS Releases Final Home Health Payment Rule

On October 30, CMS released the final rule for the home health prospective payment system for CY 2015. The measure reduces home health payments by 0.3% from 2014 payment levels and is generally consistent with the proposed rule that came out in July. Based on that payment rate, the national standardized 60-day episode payment for CY 2015 will be $2,961.38. This standardized rate constitutes a $92.11 per episode increase over the CY 2014 rate of $2,869.27.

From a policy perspective, the final rule makes several changes to the Affordable Care Act’s mandated face-to-face requirement. The rule eliminates the narrative requirement for episodes beginning on or after January 1, 2015. Also consistent with the proposed rule, the final rule provides for documentation of the face-to-face encounter in the certifying physician’s medical records and/or the acute or post-acute care facility’s medical records.

Although CMS elected not to develop a standardized form for face-to-face documentation, it appears the agency will allow home health agencies to provide physicians and facilities with summaries or copies of their comprehensive assessment that can be used by physicians as a resource as they document homebound status and the need for skilled services.

OMB Receives CMS Payment Rules

The White House Office of Management and Budget (“OMB”) has received for review various CMS payment update rules, which are slated to be released by November 1. The rules will reflect the final policy and payment rates for CY 2015.

On October 28, the OMB received both the revisions to the payment policies of the physician fee schedule and other revisions to Medicare Part B. OMB also received the End-Stage Renal Disease Prospective payment system, which includes durable medical equipment. The proposed physician rule was released on July 3 and published in the July 11 Federal Register.

On October 24, the OMB received the hospital outpatient prospective payment system policy and payment rule. The proposed hospital outpatient rule was released on July 3 and published in the July 11 Federal Register.

CDC Releases Ebola Guidance for Hospitals

On October 27, the Centers for Disease Control (“CDC”) released updated guidelines to help hospital emergency departments evaluate and manage patients with symptoms of the Ebola virus disease. The guidelines detail different approaches to asymptomatic people in four risk categories. The approaches range from high risk (someone who came into recent, unprotected contact with an infected individual’s bodily fluids) to no risk (a person who had no exposure to the virus in the previous 21 days).

Midterm Election Preview

Control of the House and Senate will be decided on November 4 in the 2014 midterm election. In the House, Republicans are expected to improve upon their current 233 to 199 seat majority (with 3 vacancies). Most election analysts predict House Republicans will pick up between 4 to 8 seats.

In the Senate, Republicans need to pick up 6 Senate seats to reach the majority of 51. While most election analysts predict Republicans will win anywhere from 4 to 8 seats in that body, there remain a number of close races that could be decided through a runoff or recount.

That scenario is most like to occur in Louisiana and Georgia.  In both states, a candidate must receive a majority as opposed to a plurality to win on Tuesday. With more than two Senate candidates on the ballots, it is expected that a runoff will be necessary in both states. If that is the case, control of the Senate may not be determined until December 6, the Louisiana runoff date, or even January 6, the Georgia runoff date.

Health Care-Related Bills Introduced This Week

There were no health care-related bills introduced this week.

Next Week in Congress

Congress remains out of session ahead of the November midterm elections.