CMS Issues Rural Add-On Instructions for Home Health Claims

Posted on Friday, December 7, 2018 1:08 AM

CMS has issued Change Request 10782, providing instructions to the Medicare Administrator Contractors (MACs) on the rural add-on for home health claims as required by the Bipartisan Budget Act (BiBA).

Starting in January, payment increases will be paid to home health agencies based on their county designation. 

The rural add-on amounts were revised by the 2018 BiBA as follows:

Low Population Density HHAs (counties with 6 or fewer people per square mile)

  • 4% add-on in 2019
  • 3% add-on in 2020
  • 2% add-on in 2021
  • 1% add-on in 2021

High utilization counties (top quartile of utilization on average)

  • 5% add-on in 2019
  • .5% add-on in 2020

All other rural areas

  • 3% add-on in 2019
  • 2% add-on in 2020
  • 1% add-on in 2021

When home health services are provided in rural (non-Core Based Statistical Area (CBSA)) areas for episodes and visits ending on or after January 1, 2019, and before January 1, 2023, a county-based rural add-on is applied to:

– The national, standardized episode rate;

– National per-visit payment rates;

– Low Utilization Payment Adjustment (LUPA) add-on payments; and

– The Non-Routine Supplies (NRS) conversion factor.

Source: NAHC Report

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