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.

Related Posts

The Future of Home Care

October 23, 2025
I've been thinking about the Future of Home Care. I was in Dallas, TX on Monday and Tuesday this week at the Home Care Association of America National Leadership Conference. What a major milestone. There were 850 Home Care providers and suppliers -- the largest attendance every. I remember pretty clearly going back to 2004…

Artificial Intelligence in Home Care

October 9, 2025
I've been thinking about the impact of AI on Home Care. Three things happened this week that have totally shifted my awareness and thinking about Artificial Intelligence. First, I've been reading a new book that was recommended to me called "Reshuffle" by Sangeet Paul Choudary. He's a senior fellow at UC Berkley, and a strategic advisor…

The 2026 Future of Home Care Study.

October 7, 2025
For the past month, I've been working with my friends at AxisCare to refine the survey for the 2026 Future of Home Care Study. This year, we have added some new questions based on last year's data, and we have added a whole new section on AI. This year's study has three major sections; Industry…