September 2, 2021

Home Health Sector Fears Cuts If CMS’ Planned Analyses Not Altered

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Inside Health Policy

Home health provider associations are worried that CMS’ proposed way of analyzing home health behavioral adjustments, aimed at keeping the revamped pay system budget neutral, could lead to big cuts down the road even though CMS is suggesting no new cuts to payment for 2022. The providers say CMS’ proposed method is contrary to Medicare law, but they aren’t yet considering legal action.

CMS in 2020 began paying home health agencies through a new system known as the patient-driven groupings model (PDGM), which aims to cut down on unnecessary therapies and focus more on patient clinical characteristics. The model also changed to reimbursing agencies based on 30-day periods of care and created 432 case mix payment groups, different multipliers that get applied to base pay rates according to a patient’s circumstances.

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