Dozens Of House Lawmakers Urge CMS To Drop Proposed Home Health Pay Cuts

About two dozen lawmakers have signed a letter urging CMS to drop two proposals that would cut pay for home health services, according to a spokesperson for Rep. Greg Walden (R-OR). The lawmakers are targeting case mix cuts and the mandatory value-based payment program.

Walden spokesperson Andrew Malcolm said there is strong, bipartisan member interest in the issue.

“We have about two dozen signed on at this point, which is a lot for August recess,” Malcolm wrote in an email. “We hope to get more when Congress comes back into session (we don’t plan to send the letter until mid-September).”

CMS proposed in July the 2016 Home Health Prospective Pay System. The proposed rule cut home health pay by 1.72 percent in each of two years on top of the pay rebasing that industry expected. The agency also proposed testing a value-based purchasing model that would put home health companies at risk for up to 8 percent pay cuts by the end of the pilot, which is far higher than similar programs for other types of providers. That program would be mandatory.

The lawmakers say the case mix cut appears to be based on an outdated analysis of 2000 and 2010 changes in case mix weights, rather than on the medical conditions of beneficiaries from 2012 to 2014 when the average case mix weights increased. Also, the cut would be on top of the four year, 14 percent rebasing, which CMS estimates will cause “approximately 40 percent” of home health companies to operate at a loss by the end of the rebasing period in 2017.

The mandatory value-based purchasing program, which would take place in nine states, withholds a much greater share of home health payments compared to value-based payment programs in other sectors, they write.

“Given the other pressures faced by HHAs, this has the potential to jeopardize access to care,” they write, referring to home health agencies. “HHAs will most likely be subject to payment penalties without the time or resources to meet the long list of 25 performance improvement measures.”

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