Military Health System

(Final Calendar Year (CY) 2024 payment amounts for 30-day periods of care.)

Title XVIII of the Social Security Act, Section 1895(b)(3)(B), requires that HHA PPS rates provided to HHAs are updated annually. The Act requires that standard prospective payment amounts for CY 2024 be increased by a factor equal to the applicable Home Health (HH) market basket for HHAs.

In order to calculate the CY 2024 national standardized 30-day episode payment for those 30-day episodes that start on or after January 1, 2024, the CY 2023 budget neutral standard amount is adjusted by the permanent behavior adjustment (BA) factor, wage-index budget neutrality factor, and the HH update factor, as reflected in Figure 12.C.2024-1.

To calculate the CY 2024 national per-visit rates, the 2023 national per-visit rates are adjusted by a wage index budget neutrality factor and CY 2024 HH update factor. The final updated CY 2024 national per-visit rates per discipline are reflected in Figure 12.C.2024-2:

For CY 2024, as described in the December 2, 2013, Centers for Medicare and Medicaid Services (CMS) Final Rule, the per-visit payment amount for the first SN, PT, and SLP visit in LUPA episodes that occur as the only episode or an initial episode in a sequence of adjacent episodes is multiplied by the LUPA add-on factors, which are: 1.8451 for SN; 1.6700 for PT; and 1.6266 for SLP.

Under the PDGM, NRS payments are included in the 30-day base payment rate. Durable medical equipment are paid separately, and they are not included in the not included in the 30-day base payment rate.

For CY 2024, the labor percent is 74.9%, and the non-labor percent is 25.1%.

Under the HHA PPS, outlier payments are made for episodes or periods of care for which the estimated cost exceeds a threshold amount. The wage adjusted Fixed Dollar Loss (FDL) amount represents the amount of loss that an agency must bear before an episode becomes eligible for outlier payments. For CY 2024, the FDL ratio is calculated at 0.27.

The methodology to calculate the outlier payment will utilize a cost-per-unit approach rather than a cost-per-visit approach. The national per-visit rates are converted into per 15 minute unit rates. The per-unit rate by discipline shall be used along with the visit length data reported on the HH claim to calculate the estimated cost of an episode to determine whether the claim shall receive an outlier payment and the amount of payment for an episode of care.

HHAs shall collect OASIS data in order to participate in the TRICARE program. The current version of the OASIS data set is available at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/OASIS-Data-Sets.html.

Effective December 31, 2023, rural add-on payments expired. HHAs should submit the CBSA code corresponding to the state and county of the patient's place of residence in value code 61 on HH claims.

On September 14, 2018, the Office of Management and Budget (OMB) issued OMB Bulletin No. 18-04, established revisions to the delineation of Metropolitan Statistical Areas (MSAs), Micropolitan Statistical Areas, and Combined Statistical Areas, and guidance on uses of the delineation in these areas. These revisions shall be adopted effective for claims with “Through” dates on or after January 1, 2021, and shall include a one-year transition cap of 5% for any decreases in wage index value from CY 2022 to CY 2023. For CY 2024, a permanent 5% cap on any decrease to a geographic area’s wage index from its wage index in the prior year applies regardless of the circumstances causing the decline.

For a complete list of new CBSA designations as well as those wage indexes affected by the 5% cap, refer to the CMS website at https://www.cms.gov/files/zip/cy-2021-hh-pps-wage-index.zip. The OMB bulletin 18-04 is located at https://whitehouse.gov/wp-content/uploads/2018/09/Bulletin-18-04.pdf.