The U.S. Centers for Medicare & Medicaid Services (“CMS”) has released final 2025 home health payment rates. The national standardized 30-day period payment amount has been computed as follows:
| 2024 National Standardized 30-day payment rate | $ 2,038.13 |
| 2025 permanent behavioral adjustment factor | .98025 |
| $ 1997.88 | |
| 2025 case-mix weight recalibration (neutrality factor) | 1.0039 |
| $ 2,005.67 | |
| 2025 wage index budget neutrality factor | .9988 |
| 2,003.26 | |
| 2020 final payment update 2025 | 1.027 |
| National Standardized 30-day payment rate | $ 2,057.35 |
The total increase (2025 rate compared to 2024 rate) is less than one percent (1%).
National Alliance for Care at Home (“Alliance”) CEO, Steven Landers, MD, MPH, stated, “While decreasing the proposed permanent rate cut and withholding the massive temporary adjustment may slow the decline of the home health benefit a bit, we need CMS to reverse course on its dismantling of this essential service through its payment model. A net increase in Medicare spending projected for 2025 does not address the several years of unwarranted rate cuts and the shortfall in recognizing the significant inflationary pressures and cost increases that have been incurred. In no way can CMS defend its actions as ‘budget neutral.’ Home health access is a life and death issue for vulnerable homebound beneficiaries.”
The final rule is available here.
PROVISION PERIOD OF ENHANCED OVERSIGHT (PPEO) EXPANSION
The final rule modifying payment rates included numerous other provisions including an expansion of home health agencies subject to PPEO. PPEO included, but is not limited, to prepayment review and payment caps. Currently the following home health agencies are subject to PPEO:
· A newly enrolling Medicare provider or supplier,
· Providers undergoing a change of ownership under CFR 489.18, and
· Providers undergoing a 100% change of ownership reported as a change of information under CFR 424.516.
The final rule now adds providers reactivating Medicare enrollment and billing privileges to those providers subjected to PPEO.
YEAR-END REVIEW OF LEIE DATABASE
All providers, including home health agencies, may be subjected to civil monetary penalties for making payments to individual or entities that have been included on the List of Excluded Individuals/Entities (“LEIE”). It is good practice to determine that new employees or new vendors are not listed on the LEIE. Additionally, at least annually all employees and vendors should be compared against the LEIE. We recommend that all providers make that comparison at the beginning of the new year and that the comparison be documented in the records of the employee and/or vendor. The increasing focus on integrity by the Medicare program provides the need for providers to establish procedures for checking employees/vendors against the list.
The LEIE was updated in October and is available here. A short video created by the OIG provides guidance on the use of the LEIE. The video is available here.
2025 ALLIANCE CONFERENCE SCHEDULED
The National Alliance for Care at Home (“Alliance”) has scheduled the 2025 Financial Management Conference for Chicago on July 27-29, 2025, and the 2025 Fall Conference for New Orleans on November 2-4, 2025. Mark these dates on your calendar.