Big Push for Home Health Payment Model Rethink

The National Association for Home Care & Hospice (NAHC) will co-sponsor with state home health associations a series of 12 one-day seminars around the country in early 2019, exploring the Patient-Driven Groupings Model (PDGM), what it will mean for home health, and how businesses can adapt to some of the most consequential regulatory changes the industry has seen.

The newly finalized Medicare home health payment model is believed to threaten continuity of care for an estimated 3.5 million homebound seniors across the U.S.

Experts, such as NAHC’s William Dombi and others, say the new payment model makes changes to Medicare reimbursement for home health services based on “untested assumptions about providers’ billing behavior, rather than any actual, evidence-based changes triggered by the new payment model that affect overall Medicare spending on home health services.” And, they say Medicare is likely to arbitrarily cut reimbursement rates to home health agencies by 6.42 percent in the first year.

Three bills have been introduced in the House and Senate that, if passed, would require Medicare to adjust reimbursement rates only after behavioral changes by home health agencies actually occur. The bipartisan bills (S. 3545, S.3458, and H.R. 6932), sponsored by Sens. Susan Collins (R-Maine), Debbie Stabenow (D-Mich.) and Bill Nelson (D-Fla.), John Kennedy (R-La.) and Bill Cassidy (R-La.), and Reps. Ralph Abraham (R-La.), Garrett Graves (R-La.), Scott DesJarlais (R-Tenn.), Vern Buchanan (R-Fla.), and Terri Sewell (D-Ala.) would stabilize access to care while the Centers for Medicare & Medicaid Services and stakeholders work together to improve Medicare payment reforms.

Home health leaders representing the Council of State Home Care & Hospice Associations, NAHC, the Partnership for Quality Home Healthcare and 11 state home care associations visited Capitol Hill Wednesday, November 28, to advance the bipartisan, bicameral Medicare home health legislation. They want to see Congress act during the final weeks of this legislative session.

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