July 9, 2019

Sens., Reps. Ask CMS To Reconsider Home Health Pay Cut In 2020 Rule

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Inside Health Policy

A bipartisan, bicameral group of lawmakers asks CMS to revisit provider cuts resulting from a new home health pay system, scheduled to go into effect next year, when the agency releases the 2020 home health pay rule.

CMS typically releases the proposed 2020 pay rules in July, including the home health rule. Sens. Susan Collins (R-ME) and Debbie Stabenow (D-MI), along with Reps. Vern Buchanan (R-FL) and Terri Sewell (D-GA), say the agency should take another look at its assumptions, included in home health rules released last year, that would lead to a more than 6% cut under the new home health pay system.

The Bipartisan Budget Act of 2018 required a move from 60-day episodes of care to 30-day episodes of care under the home health prospective pay system. But, unlike an earlier CMS proposal that would have cut nearly $1 billion from Medicare pay, the law required the change to be implemented in a budget-neutral way in 2020.

The law required CMS to account for expected changes in coding or other home health agency practices when setting the base rate for the new system in 2020, and as part of the pay rule for 2019, which CMS used to lay out its plans for the new home health pay system, the agency called for an episode payment reduction of 6.42% to account for that. However, CMS also said final changes to pay amounts in 2020 have yet to be set.

The lawmakers say CMS should revisit its assumptions since the Bipartisan Budget Act of 2018 wasn’t intended to create consequential cuts in 2020. The lawmakers also say that CMS’ reductions came from assumptions that lack real-world evidence about the home health agencies’ actions under the new system.

Click here to see the full article on the Inside Health Policy website.