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Status report on implementation of the home health agency prospective payments demonstration.

The following summary is of a report from the Secretary of Health and Human Services released to Congress on December 9, 1991. Legislative mandate

Section 4027 of Public Law 100-203, the Omnibus Budget Reconciliation Act (OBRA) of 1987, mandated a demonstration to develop and test alternative methods of paying home health agencies (HHAs) on a prospective basis for services furnished under the Medicare and Medicaid programs.

The legislation requires that a final report on the results of the project be submitted not later than 4 years after enactment of the law. Because the demonstration did not begin operations until 1990, evaluation results are not available. Instead, the report describes the status of implementation of the demonstration and current plans for its evaluation.

Overview

The report contains the following highlights: * The HHA Prospective Payment Demonstration will

test two types of prospective payment rates in two

phases: Per-visit payment rates by type of home

health service are being tested in Phase 1 (which

began in October 1990); and, per-episode payments

for each episode of Medicare-covered home health

care will be tested in Phase 2 of the project, scheduled

to begin in late 1992. * The Health Care Financing Administration (HCFA)

began a comprehensive set of site recruitment and

implementation activities for the first phase of the

project in 1990. In response to a comprehensive

recruitment effort undertaken by HCFA, 49 HHAs

signed agreements to participate in the

demonstration. * In September 1990, HCFA awarded a contract to

Mathematica Policy Research, Inc., to perform an

independent evaluation of Phase 1 of the

demonstration. This evaluation will provide

information about the effects of the per-visit

prospective payment method, suggest changes that

would be appropriate in any national HHA

prospective payment system (PPS), and propose

refinements to plans for Phase 2 based on the

information gathered during the first year of Phase 1.

Policy implications

Section 4207 of OBRA 1990 requires the development of a proposed PPS for Medicare home health services. This section directs that the Department of Health and Human Services submit to Congress by April 1, 1993, a report of the research findings on which the proposed system will be based, and a report of the proposed PPS by September 1, 1993. Although the results of this demonstration will not be available when these reports are being prepared, these reports will reflect the issues and factors that were considered during the design of the project, as well as any available information from the data collected during the first year of the demonstration.

Program contact

For further information: Mr. Tony Hausner Office of Research and Demonstrations Health Care Financing Administration Room 2-F-5 Oak Meadows Building 6325 Security Boulevard Baltimore, Maryland 21207 Telephone (410) 966-6662

Skilled Nursing Facilities Prospective Payment Demonstration Report on Research Findings

The following summary is of a report from the Secretary of Health and Human Services released to Congress on January 22, 1992.

Legislative mandate

Section 4008(k) of the Omnibus Budget Reconciliation Act of 1990 states, in part: "(1) The Secretary of Health and Human Services shall develop a proposal to modify the current system under which skilled nursing facilities receive payment for extended care services under Part A of the Medicare program or a proposal to replace such a system with a system under which such payments would be made on the basis of prospectively determined rates .... 2)(A) By not later than April 1, 1991, the Secretary (acting through the Administrator of the Health Care Financing Administration) shall submit any research studies to be used in developing the proposal . . . .

Overview

The report highlights results from 28 studies that were identified as having direct relevance to modifying the current system under which skilled nursing facilities (SNFs) receive Medicare payment. The studies synopsized in the report include research supported by the Health Care Financing Administration (HCFA) on the development of such topics as case-mix adjusted payment systems, bundling of acute and post-acute expenditures, and hospital swing beds. Also included in the report are synopses of the 1985 and 1988 Reports to Congress on Medicare prospective payment for SNFs and reports on other non-HCFA-funded research that are relevant to the issue.

Program contact

For further information: Mr. J. Donald Sherwood Office of Research and Demonstrations Health Care Financing Administration Room 2-F-4 Oak Meadows Building 6325 Security Boulevard Baltimore, Maryland 21207 Telephone (410) 966-6652
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Title Annotation:Legislative Update; Reports to Congress
Publication:Health Care Financing Review
Date:Jun 22, 1992
Words:721
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