On Oct. 31, 2022, the Centers for Medicare & Medicaid Services (CMS) released the Home Health Prospective Payment System (HHPPS) Final Rule for Calendar Year (CY) 2023, which included a permanent 7.85% payment cut to Medicare home health services.
While the Final Rule offers some minimal, short-term relief by instituting a phased-in payment reduction of 3.925% for CY 2023, the cuts over the next 10 years will be even more serious because the finalized, permanent rate cut is larger than what was initially proposed. In total, these cuts will reach over $18.15 billion in the next ten years. CMS also still plans to apply additional “clawback cuts” of more than $2 billion for services provided to patients during the COVID-19 pandemic.
Since CMS implemented the PDGM model, the Partnership has consistently outlined concerns related to CMS’ budget neutrality methodology while also highlighting significant increases in labor and supply costs across the home health community. As the Partnership has noted, the CMS methodology to determine budget neutrality in the home health payment system is flawed.
Access to Medicare home health care services is vital to the health, safety, and rehabilitation of America’s seniors and people with disabilities. These payment adjustments will jeopardize the stability of this vital sector and risk access to Medicare home health services.
To read the Partnership’s statement on the Final Rule, click here.
Fortunately, lawmakers in Congress have recognized the dire impacts that massive long-term cuts will have on home health providers and the patients they serve.
U.S. Senators Debbie Stabenow (D-MI) and Susan Collins (R-ME) and Representatives Terri Sewell (D-AL) and Vern Buchanan (R-FL) have introduced The Preserving Access to Home Health Act of 2022 (S.4605/H.R. 8581), which would delay the 7.69% payment cut proposed for 2023 and block the additional “clawback” cuts that are set to begin as soon as 2024.
Specifically, the Preserving Access to Home Health Act will make the following policy changes:
- Prevent CMS from implementing any permanent or temporary adjustment to home health prospective payment rates prior to 2026. This would delay cuts currently proposed by CMS for 2023 and beyond, allowing more time for CMS to refine its proposed approach to determining budget neutrality in home health.
- Ensure that any adjustments CMS determines to be necessary to offset increases or decreases in estimated aggregate expenditures are made by 2032, such that no cuts would be delayed beyond the end of the budget window.
- The legislation is intended to be self-implementing. It would become effective as of the date of enactment and includes instructions allowing for implementation by program instruction or other means.
Recent polling, conducted by Morning Consult on behalf of the Partnership, found widespread and deep support for Medicare home healthcare services and the need to prevent Medicare home health cuts. Notably:
- 97% of Medicare beneficiaries want the federal government to maintain Medicare coverage for at-home health care services.
- 65% of voters oppose CMS implementing a cut to Medicare home health services.
- 92% of registered voters believe it is important for the federal government to maintain Medicare coverage for at-home health care to allow seniors to recover and rehabilitate at home. There is also wide bipartisan agreement among registered voters with 94% of Democrats and 93% of Republicans expressing their support for the Medicare home health program.
- Three in five voters (60%) and more than three in four (76%) voters 65+ would be less likely to support their Member of Congress if they were in favor of making these cuts to Medicare home health services.
- More than three in four voters (78%) believe it is important for Congress to pass legislation to push back on CMS’ proposed payment cuts to Medicare home health services, including nine in ten voters 65+ (88%), Medicare beneficiaries (88 percent), and caregivers for 65+ adults (89%).
The home health community is committed to protecting access to home health by working with Congress to prevent these vital services from facing permanent and temporary reductions.