CY 2018 Home Health PPS Final Rule: Final Changes to HH QRP

December 14, 2017

CMS continues to seek public comment on which social risk factors might be most appropriate for reporting stratified measure scores and potential risk adjustment of a particular measure. Examples: dual eligible/low-income subsidy, race and ethnicity and geographic area of residence.

The rule finalized the Data Elements for removal from OASIS: 247 data elements from 35 OASIS items collected at specific time points will be removed. These elements are not used in the calculation of quality measures nor are they used for payment, survey, value-based purchasing (VBP) or care planning.

The rule finalized three new Post Acute Care (PAC) setting measures under the domains in accordance with the IMPACT Act.  These measures will require the beginning of collection to be January 2019.  CMS finalized the new measures without any changes from what was included in the originally proposed rule.  The three new measures are as follows:

  1. Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury (this measure replaces the measure entitled Skin Integrity and Changes in Skin Integrity Domain - Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay))
  2. Functional Status, Cognitive Function, and Changes in Function and Cognitive Function Domain
  3. Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631)

CMS proposed to begin collecting in 2019 standardized assessment data items under five domains:

  1. Functional Status
  2. Medical Conditions and Co-morbidities
  3. Cognitive Function and Mental Status
  4. Special Services, Treatments
  5. Interventions and Impairments

CMS only finalized standardized assessment data under two of the five domains:

  1. Functional Status:   CMS will apply the assessment items for the measure “Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631)”, to meet the requirements for this domain.
  2. Medical Conditions and Co-Morbidities: CMS will use elements needed to calculate the measure for pressure ulcers, such as diabetes, incontinence, peripheral vascular disease or peripheral arterial disease, mobility, as well as low body mass index (BMI), to meet the requirements for this domain.

CMS finalized the plans to begin public reporting in 2019 on the following OASIS and claim based measures that agencies began collecting in 2017.

  • Percent of Patients or Residents with Pressure Ulcers that are New or Worsened
  • Drug Regimen Review
  • Medicare Spending Per Beneficiary
  • Discharge to Community
  • Potentially Preventable 30-Day Post-Discharge Readmission

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