November 28, 2018

Nation’s Home Health Leaders Visit Capitol Hill in Support of Legislation to Refine Medicare Home Health Payment Reforms

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Bipartisan legislation modifies Patient Driven Groupings Model to ensure consistent patient access to home healthcare before 2020 implementation

WASHINGTON– Home health leaders representing the Council of State Home Care & Hospice Associations, National Association for Home Care & Hospice (NAHC), Partnership for Quality Home Healthcare and eleven state home care associations visited Capitol Hill today to advance bipartisan, bicameral Medicare home health legislation that refines a new home health payment model to ensure beneficiary access to quality care is not compromised for America’s growing senior population.

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 to ensure the delivery of consistent, clinically effective and high quality home health services.

“We are on Capitol Hill today urging lawmakers in Congress – while they still have time in the final weeks of this legislative session – to support and act on home health payment reform legislation so we can make sure reforms are designed and implemented in a way that puts patient need at the center of decision making,” said Keith Myers, Chairman of the Partnership for Quality Home Healthcare.

The Patient Driven Groupings Model (PDGM), finalized by CMS in the Home Health Perspective Payment System (HHPPS) Final Rule for 2019, alters Medicare payments for home health services based on untested assumptions about providers’ billing behavior, rather than any actual, evidence-based changes. As a result, Medicare is likely to cut reimbursement rates to home health agencies by 6.42 percent – equaling more than $1 billion – in 2020 alone based on these assumed changes.

The home health legislation instead requires Medicare to institute rate adjustments only after home health agency (HHA) behavioral changes occur, basing any behavioral payment adjustment on real, observed evidence. Further, it will ensure Medicare budget neutrality but require the phase-in of any necessary rate increases or decreases to be no greater than 2 percent per year to limit the risk of disruptions in patient care.

“With more than half of home health agencies bracing for such sharp and unexpected reimbursement reductions, we have raised constructive concern with both CMS and Congress that these cuts may lead to unintended consequences – most notably a disruption in care for beneficiaries requiring home health to prevent expensive rehospitalizations, manage chronic conditions and assist seniors following an acute episode of care,” said Bill Dombi, President of NAHC.

The home health leaders also stress the new payment model should be treated like other Medicare payment systems. A behavioral assumption cut without data is not sound payment policy. CMS, in issuing the Skilled Nursing Facility (SNF) model, refused to make assumptions about provider behavior, stating that it would “not make any attempt to anticipate or predict provider reactions to the implementation of the proposed [payment model].” The home health payment model should be treated in the same way as other payment models: by using a data-drive approach to behavioral assumptions.

“Our elderly, homebound patients can’t afford cuts that threaten their care – particularly when CMS hasn’t provided any rationale for them,” added Tim Rogers, Chair of the Council of State Home Care & Hospice Associations. “Rather than enacting changes to reimbursement based in assumptions under the PDGM, it’s critical that our policymakers follow the facts and act upon evidence.”