Payment updates
Market basket update
CMS proposes a 2.7% market basket update and projects this to result in an overall increase of $540 million to home Healthcare payments in CY 2021.
Low Utilization Payment Adjustment (LUPA)
CMS would maintain the current LUPA thresholds for CY 2021 payment, since there is not enough data to update under the new PDGM model.
Case-mix weights
CMS proposes to proceed with the current case-mix weights for CY 2021, since there is not enough data to update those related to PDGM.
Wage-index update
CMS looks to adopt the revised Office of Management and Budget (OMB) statistical area delineations from OMB Bulletin No. 18-041 for the labor market delineations used in the home Healthcare wage index, effective beginning in CY 2021. CMS also proposes to cap any wage index decrease in excess of 5% for one year. [CMS has made this proposal across its other annual updates, such as the inpatient prospective payment system rule.]
Standard 30-day period payment
CMS does not make any behavioral adjustments or changes due to the newness of the PDGM and the ongoing COVID-19 pandemic. The national standardized amount for CY 2021 is $1,911.87.