May 8, 2019

Home Health Leaders Applaud House Introduction of Legislation to Strengthen Medicare Home Health Reforms

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WASHINGTON – Home health leaders with the Partnership for Quality Home Healthcare (Partnership) and National Association for Home Care & Hospice (NAHC) today commended lead bill sponsors Representatives Terri Sewell (AL-07), Vern Buchanan (FL-16) and Ralph Abraham (LA-05) for introducing  H.R. 2573, bipartisan legislation to improve home health payment reforms to ensure behavioral-based payment adjustments to the Medicare home health benefit are rooted in evidence and observed data. Other original co-sponsors applauded for their support include Representatives Ann McLane Kuster (NH-02), Kenny Marchant (TX-24), Jodey Arrington (TX-19), Garret Graves (LA-06), Jimmy Panetta (CA-20), John Larson (CT-1), Mac Thornberry (TX-13) and Scott DesJarlais (TN-04).

The home health provider community is lauding the legislation as a step toward protecting beneficiary access to quality care services which otherwise could be compromised for America’s growing senior population.

“We fully support this Medicare legislation to protect beneficiary access to home health services. We look forward to working with this bipartisan group of bill sponsors – and their bipartisan colleagues in the Senate – to advance this important legislation,” said Keith Myers, Chairman of the Partnership for Quality Home Healthcare. “This bill will prevent disruptions in patient care by ensuring that home health payments to providers of care are not cut by $1 billion in 2020. This legislation also protects the home health program at a time when we are moving to a new payment system that will better align payment with a patient’s true health needs and conditions.”

“This legislation is a bipartisan, bicameral recognition that home health services are essential to the health and safety of Medicare beneficiaries,” said Bill Dombi, President of the National Association for Home Care & Hospice (NAHC). “They should not be placed at risk by a regulatory action that is based on nothing more than guesses and assumptions as to how providers of care may react to a new payment model. Medicare beneficiaries deserve better. The bill’s sponsors are putting patients first and we applaud them for doing so.”

The bill specifically addresses reforms made in the Patient Driven Groupings Model (PDGM), a payment model proposed by the Centers for Medicare & Medicaid Services (CMS) last year and slated for implementation in 2020.  If implemented as designed, PDGM will make payment adjustments based on behavioral assumptions as opposed to observed evidence or actual provider billing behaviors. The new payment structure could result in a 6.42 percent payment reduction in the first year alone – equaling an estimated $1 billion.

If passed, H.R. 2573 will require Medicare to implement adjustments to reimbursement rates only after behavioral changes by home health agencies (HHAs) actually occur instead of assuming billing changes might happen. By requiring the payment model to utilize observed evidence of behavioral changes, the bill would ensure a smoother transition to the new payment system. The bill also  provides a phase-in of payment changes, limiting losses or gains to two percent per year, while still ensuring budget neutrality is maintained.

“We remain concerned that without the elimination of the behavioral assumption cut, PDGM could lead to instability to all providers, threaten access to care and harm the Medicare home health program for seniors,” added Myers.

A Senate companion bill (S. 433) was introduced by Senators Susan Collins (R-ME) and a bipartisan group of her colleagues in February including: Sens. Debbie Stabenow (D-MI), John Kennedy (R-LA), Bill Cassidy (R-LA), Rand Paul (R-KY), Doug Jones (D-AL), and Jeanne Shaheen (D-NH).