CMS releases CY 2025 home health PPS final rule, partially delays behavioral adjustments

The Centers for Medicare & Medicaid Services Nov. 1 issued its calendar year 2025 final rule for the home health prospective payment system. Overall, this rule will increase HH payments by $85 million, or 0.5% compared to CY 2024. This update is the result of a 3.2% market basket update, offset by a 0.5% productivity reduction. In addition, CMS says payments will be reduced by 0.4% overall due to changes to fixed-dollar loss ratio for outlier payments. Further, CMS is applying a behavioral adjustment of -1.8% as required as part of implementation of the new Patient Driven Groupings Model. This is half of the -3.6% reduction CMS proposed; the agency states that it will apply the remainder of this permanent adjustment in future years.

For the HH quality reporting program, CMS finalized its proposal to adopt four new standardized patient assessment data elements related to social determinants of health beginning with the CY 2027 program. In addition, the agency finalized a new Medicare Condition of Participation that sets standards for patient acceptance-to-service policies for HH agencies, as well as a new data reporting standard on respiratory illnesses for long-term care facilities beginning Jan. 1.