THE ISSUES

While evidence already confirms that home healthcare is a cost effective care setting with positive clinical outcomes for patients, the Partnership is working to further improve quality and access for the patients we serve.

PATIENT DRIVEN GROUPINGS MODEL

In the Home Health Prospective Payment System (HHPPS) Final Rule for FY2020, the Centers for Medicare & Medicaid Services (CMS) finalized plans to implement a new payment model for home health services in 2020, known as the Patient Driven Groupings Model or PDGM. Under the Bipartisan Budget Act (BBA) of 2018, the model must be budget neutral and change payment from a 60-day unit to a 30-day unit. It also mandates Medicare to apply “behavioral adjustments” to account for changes in provider behavior unrelated to changes in patients served or services delivered that increase payments.

In the HHPPS Final Rule for 2020, CMS used this authority to institute an adjustment in the first year of PDGM based solely on assumptions of behavior change that might occur in 50 percent of the episodes of care. Therefore, CMS will use behavioral assumptions in adjusting the payment rate for half the 30-day episodes of care, opposed to all 30-day episodes of care in 2020, which reduces the first year payment cut to 4.36 percent from a previously planned 8.01 percent.

Under the new model, the volume of therapy visits as a payment level determinant cannot be used as a basis for payment – in contrast to the Home Health Perspective Payment System (HHPPS) model in effect since October 2000.

The Partnership appreciates that CMS leaders responded to the home health community’s comments and feedback. As payment system changes under PDGM are implemented in 2020, the Partnership will be monitoring the impacts on care delivery and patient access as providers navigate the new system. The Partnership will share its observations with CMS and our legislative champions in Congress to ensure the continued provision of quality home healthcare to Medicare beneficiaries nationwide.