CMS Issues Final Rule on 2025 Home Health Prospective Payment Systems

The Centers for Medicare and Medicaid Services (CMS) issued a final rule on its 2025 home health prospective payment system, which updates Medicare payment policies and rates for home health agencies. This rule will also provide updates to the intravenous immune globulin (IVIG) items and services’ payment rates for durable medical equipment suppliers.

With this final rule, CMS finalized a permanent prospective adjustment of -1.975 percent (half of the calculated permanent adjustment of -3.95 percent) to the 2025 home health payment rate, which seeks to clarify the impact of implementing patient-driven grouping models. CMS said this adjustment aims to account for differences between assumed and actual behavior changes on estimated aggregate expenditures. Additionally, CMS applied a 3.925 percent reduction for 2023 and a 2.890 percent reduction for 2024, which were half of the estimated required permanent adjustments.

As part of this final rule, CMS is deciding upon a crosswalk for mapping responses on the current outcome and assessment information set (OASIS), OASIS-E — in response to the prior OASIS set, OASIS-D — with the intention of analyzing the difference between assumed and actual behavior changes on estimated aggregate expenditures, recalibrated patient-driven grouping model case-mix weights and updated low-utilization payment adjustment (LUPA) thresholds, functional impairment levels and comorbidity adjustment subgroups. Additionally, CMS intends to finalize and adopt the most recent office of management and budget core-based statistical area delineations for home health wage indexes; an occupational therapy low-utilization payment adjustment add-on factor and updated physical therapy, speech-language pathology and skilled nursing low-utilization payment adjustment add-on factors; and an updated 2025 fixed-dollar loss ratio for outlier payments.

This final rule settles the rate update for the 2025 IVIG items and services’ payment under the IVIG benefit. Additionally, CMS is finalizing updates to the home health agency conditions of participation, which aim to reduce avoidable care delays by helping ensure that referring entities and prospective patients can select the most appropriate home health agency based on their care needs.