When President Obama signed the "Patient Protection and Affordable Care Act" (PPACA) into law on March 23, he reinstated the temporary Medicare home health rural add-on payment at 3 percent (Sec. 3131) for providers who serve patients in rural areas. Effective April 1, the add-on applies to episodes ending on or after April 1, 2010 through Dec. 31, 2016. According to the National Association for Home Care & Hospice, all claims that report a rural state code (i.e., a code beginning with "999") as the Core-Based Statistical Area (CBSA) code for the beneficiary's residence will receive the additional 3 percent payment. The CBSA code is associated with value code 61 on home health claims.

The home care industry has not seen a rural add-on payment since 2006, when providers received a 5 percent add-on payment for rural home health episodes from the "Deficit Reduction Act of 2005." With US gas prices currently averaging $2.83 per gallon, this rural add-on payment will specifically help nurses, therapists, home care aides, and other homecare providers doing their best to serve elderly and disabled patients living in remote areas of the country.

Reactions to this change have been strong. Kristi R. Wheeler, RN, HCS-D, COS-C, Clinical Consultant for Kinnser Software, Inc., and the owner of ACCS (Agency Compliance & Consulting Service, LLC.) stated, "I am pleased to see the rural add on reinstated. Rural areas are typically harder to staff due to limited availability of clinicians, and the costs to commute are higher because of long distances between patients. Many of these patients experience delays with admission to home health as it is more difficult to staff patients in rural areas."

David Tapia, MBA, ACHE, Managing Partner, Exegete Consultants, LLC. stated, "In light of recent scrutiny of the home health industry on a federal level, the rural add-on payment is a step in the right direction and acknowledges the crucial role agencies play in the overall continuum of care. Rural health has been in great need of attention; and delivering consistent, quality healthcare has been a challenge. Increased reimbursement will hopefully begin to launch incentives for providers to take a second look at [expanding] their service area [to meet the needs of this patient population]."

Stay tuned to the Kinnser blog for more information regarding the momentous health care reform bill and the implications it will have on home care and hospice industries.

*Based on a 2008 study, home health providers drive nearly 5 billion miles each year. How many miles do you drive? If you are a home health clinician (e.g., RN, Aide, PT/PTA, OT/COTA, SLP/SLPA, and MSW), please tell us how many miles you drive with this 2-minute survey. We will share the results of this survey Monday, April 26.*