October 9, 2020

Home Health Leaders Applaud Senator Susan Collins for Asking CMS to Eliminate 4.36% Home Health Payment Cuts

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WASHINGTON – The Partnership for Quality Home Healthcare – a coalition of home health leaders dedicated to developing innovative reforms to improve the program integrity, quality, and efficiency of home healthcare for our nation’s seniors – today commended Senator Susan Collins (R-ME) for sending a letter to the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma urging the  elimination of the 4.36% “behavioral assumption” rate reduction in the home health payment system for 2021.

“The Partnership applauds Senator Collins for her continued leadership on Medicare home health issues, including efforts to ensure Medicare’s new payment model does not impede the delivery of home health to our vulnerable patient population, especially as we continue to navigate the challenges of the COVID-19 crisis, ” said Joanne Cunningham, Executive Director of the Partnership. “We hope CMS will consider the concerns flagged by Senator Collins – as well as other lawmakers in Congress – and eliminate the 4.36 percent cut in their final payment rule for 2021.”

“I request that CMS reevaluate its proposal to carry forward behavioral assumptions developed well before the start of the COVID-19 public health emergency and consider eliminating the 4.36 percent behavioral assumption rate reduction for CY 2021. As we look for ways to ensure that the pandemic does not create devastating long-term health consequences due to delayed care, it is critically important that CMS avoid undue payment cuts that could threaten access to home health care services for vulnerable seniors and individuals with disabilities,” Senator Collins wrote to CMS.

A recent analysis of 2020 Medicare data examining home health use and provider behavior in response to the new Patient Driven Grouping Model (PDGM) payment system found that home health provider’s actual behaviors have been inconsistent with the behavioral assumptions described by CMS as the basis for thee cut. Further, the data show that PDGM was not implemented in a budget neutral manner, as required by Congress.

“As the sponsor of the Home Health Payment Innovation Act of 2019, I continue to believe that CMS should base these behavioral adjustments on observed evidence, rather than on assumptions of potential provider behavioral changes, and that any necessary rate increases or decreases should be phased in to limit the risk of disruption in care. I am aware that while CMS believes it does not yet have sufficient data to recommend changes to the behavioral adjustment, a third-party analysis of Medicare claims data indicates that in the first four months of 2020, home health spending was significantly lower than projected, and a subsequent analysis of May and June claims data indicates that these trends have continued,” Collins further wrote.

To read the Senator Collins’ letter to CMS, CLICK HERE.

To read more about the PDGM home health cut, CLICK HERE.