Current through Register Vol. 41, No. 3, September 23, 2024
A. Effective for dates of services on and
after July 1, 1991, the Department of Medical Assistance Services (DMAS) shall
reimburse home health agencies (HHAs) at a flat rate per visit for each type of
service rendered by HHAs (i.e., nursing, physical therapy, occupational
therapy, speech-language pathology services, and home health aide services.) In
addition, supplies left in the home and extraordinary transportation costs will
be paid at specific rates.
B.
Effective for dates of services on and after July 1, 1993, DMAS shall establish
a flat rate for each level of service for HHAs by peer group. There shall be
three peer groups:
(i) the Department of
Health's HHAs,
(ii) non-Department
of Health HHAs whose operating office is located in the Virginia portion of the
Washington DC-MD-VA metropolitan statistical area, and
(iii) non-Department of Health HHAs whose
operating office is located in the rest of Virginia. The use of the Health Care
Financing Administration (HCFA) designation of urban metropolitan statistical
areas (MSAs) shall be incorporated in determining the appropriate peer group
for these classifications.
The Department of Health's agencies are being placed in a
separate peer group due to their unique cost characteristics (only one
consolidated cost report is filed for all Department of Health
agencies).
C.
Rates shall be calculated as follows:
1. Each
home health agency shall be placed in its appropriate peer group.
2. Department of Health HHAs Medicaid cost
per visit (exclusive of medical supplies costs) shall be obtained from its 1989
cost-settled Medicaid cost report. Non-Department of Health HHAs Medicaid cost
per visit (exclusive of medical supplies costs) shall be obtained from the 1989
cost-settled Medicaid Cost Reports filed by freestanding HHAs. Costs shall be
inflated to a common point in time (June 30, 1991) by using the percent of
change in the moving average factor of the Data Resources Inc., (DRI), National
Forecast Tables for the Home Health Agency Market Basket (as published
quarterly).
3. To determine the
flat rate per visit effective July 1, 1993, the following methodology shall be
utilized:
a. The peer group HHAs per visit
rates shall be ranked and weighted by the number of Medicaid visits per
discipline to determine a median rate per visit for each peer group at July 1,
1991.
b. The HHA's peer group
median rate per visit for each peer group at July 1, 1991, shall be the interim
peer group rate for calculating the update through January 1, 1992. The interim
peer group rate shall be updated by 100% of historical inflation from July 1,
1991, through December 31, 1992, and shall become the final interim peer group
rate that shall be updated by 50% of the forecasted inflation to the end of
December 31, 1993, to establish the final peer group rates. The lower of the
final peer group rates or the Medicare upper limit at January 1, 1993, will be
effective for payments from July 1, 1993, through December 1993.
c. Separate rates shall be provided for the
initial assessment, follow-up, and comprehensive visits for skilled nursing and
for the initial assessment and follow-up visits for physical therapy,
occupational therapy, and speech therapy. The comprehensive rate shall be 200%
of the follow-up rate, and the initial assessment rates shall be $15 higher
than the follow-up rates. The lower of the peer group median or Medicare upper
limits shall be adjusted as appropriate to assure budget neutrality when the
higher rates for the comprehensive and initial assessment visits are
calculated.
4. The fee
schedule shall be adjusted annually beginning July 1, 2010, based on the
percent of change in the moving average of the National Forecast Tables for the
Home Health Agency Market Basket published by Global Insight (or its successor)
for the second quarter of the calendar year in which the fiscal year begins.
The report shall be the latest published report prior to the fiscal year. The
method to calculate the annual update shall be:
a. All subsequent year peer group rates shall
be calculated utilizing the previous final peer group rate established on July
1.
b. The annual July 1 update
shall be compared to the Medicare upper limit per visit in effect on each
January 1, and the HHAs shall receive the lower of the annual update or the
Medicare upper limit per visit as the final peer group rate.
D. Effective July 1,
2009, the previous inflation increase effective January 1, 2009, shall be
reduced by 50%.
E. Effective July
1, 2010, through June 30, 2016, there shall be no inflation adjustment for home
health agencies. Effective July 1, 2017, through June 30, 2018, the annual fee
schedule adjustment for inflation shall be reduced by 50%.
Statutory Authority: §
32.1-325 of the Code of
Virginia; 42 USC §
1396 et
seq.
