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Affordable Care Act (ACA) Case Mix Rebasing Mandate

Brooke Phillips, CWCMS
Editor | Shield HealthCare
09/30/15  4:45 PM PST
Case Mix Rebasing

Case Mix Rebasing: ACA Text

The Patient Protection and Affordable Care Act of 2010 (PPACA) required Medicare to rebase home health payment rates beginning in 2014, and to phase in any adjustments in equal increments over a four (4) year period.  Here is the text of the case mix rebasing mandate as put forth by the ACA:

SEC. 3131. PAYMENT ADJUSTMENTS FOR HOME HEALTH CARE.

(a) REBASING HOME HEALTH PROSPECTIVE PAYMENT AMOUNT.—

(1) IN GENERAL.—Section 1895(b)(3)(A) of the Social Security Act (42 U.S.C. 1395fff(b)(3)(A)) is amended— (A) in clause (i)(III), by striking ‘‘For periods’’ and inserting ‘‘Subject to clause (iii), for periods’’; and (B) by adding at the end the following new clause:

‘‘(iii) ADJUSTMENT FOR 2013 AND SUBSEQUENT YEARS.—

‘‘(I) IN GENERAL.—Subject to subclause (II), for 2013 and subsequent years, the amount (or amounts) that would otherwise be applicable under clause (i)(III) shall be adjusted by a percentage determined appropriate by the Secretary to reflect such factors as changes in the number of visits in an episode, the mix of services in an episode, the level of intensity of services in an episode, the average cost of providing care per episode, and other factors that the Secretary considers to be relevant. In conducting the analysis under the preceding sentence, the Secretary may consider differences between hospital-based and freestanding agencies, between for-profit and nonprofit agencies, and between the resource costs of urban and rural agencies. Such adjustment shall be made before the update under subparagraph (B) is applied for the year.

‘‘(II) TRANSITION.—The Secretary shall provide for a 4-year phase-in (in equal increments) of the adjustment under subclause (I), with such adjustment being fully implemented for 2016. During each year of such phase-in, the amount of any adjustment under subclause (I) for the year may not exceed 3.5 percent of the amount (or amounts) applicable under clause (i)(III) as of the date of enactment of the Patient Protection and Affordable Care Act.’’

Click here to learn more about the proposed rule released by CMS regarding Case Mix Rebasing in 2016:  Concern Grows over $350 Million Medicare Cut to Home Health Agencies in 2016

References:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/Downloads/Analyses-in-Support-of-Rebasing-and-Updating-the-Medicare-Home-Health-Payment-Rates-Technical-Report.pdf

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