Coming Changes to Medicare PPS

Stephen Tweed | October 15, 2006 | Newsroom
Mary St. Pierre, Vice President for Regulatory Affairs brought us up to date on the proposed changes to Medicare PPS. CMS wants to create a "more equitable distribution of funds."Some of the changes:Adjustments to SCIC, PEP, and LUPAsAdjustments to reimbursement for Medical SuppliesRevisions to the Case MixCase Mix Revisions include:Diagnosis and co-morbidityA "4 equation model"Multiple…

Mary St. Pierre, Vice President for Regulatory Affairs brought us up to date on the proposed changes to Medicare PPS. CMS wants to create a “more equitable distribution of funds.”

Some of the changes:

  • Adjustments to SCIC, PEP, and LUPAs
  • Adjustments to reimbursement for Medical Supplies
  • Revisions to the Case Mix

Case Mix Revisions include:

  • Diagnosis and co-morbidity
  • A “4 equation model”
  • Multiple therapy thresholds
  • Smoothing between thresholds

The target is to have these revisions implemented by January of 2008, which means the proposed rule will be drafted by January 2007, have a 60 day comment period, and write the final rule by July or August 2007. Stay tuned to NAHC or your state home care association for more updates on these revisions.

What are your thoughts on the proposed PPS changes? Add your comments below.

Stephen Tweed
Stephen Tweed is among the top Thought Leaders in Home Care today. As an industry researcher, author, and executive coach, he has worked with owners and CEOs of companies in the top 5% of Home Care and is a frequent speaker at Home Care association conferences and corporate meetings across the US and Canada.

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