Wednesday, the day of the release of the home health final rule, was not an easy one for home health and hospice providers. Both industries engaged in robust lobbying campaigns to steer the Centers for Medicare & Medicaid Services away from certain proposals. In both cases, CMS seemed to be saying, thank you very much for playing. Try again.

Home health providers, of course, were hoping for CMS to relent on the permanent behavioral adjustment related to the transition to the Patient-Driven Groupings Model. Instead, CMS slapped the industry with a 2.89% reduction.

And hospice providers, through countless letters and lobbying and conversations, were pushing for a new algorithm for determining the candidates for the Special Focus Program. And, again, CMS said, tough luck. We’re sticking with the algorithm we got.

It was not unlike in the Wizard of Oz when Dorothy and her trusted friends — who each possessed a wish they’d like granted — overcome many obstacles, including encounters with the Wicked Witch, sleep-inducing poppies and their own insecurities, to finally arrive at Oz. When they meet the wizard, he tells them, come back later. I’m busy.

This deliberate decision to override their concerns was not lost on the providers.

“It is disappointing that Medicare did not stop these cuts despite outreach from home healthcare providers, caregivers, Medicare beneficiaries and their families,” said David Baiada, chair of the Partnership for Quality Home Healthcare, in a statement. “Our congressional representatives have made it known that they’ve heard us on these cuts, so now it’s time for Congress to make home healthcare a priority and protect access to care for our most vulnerable neighbors and loved ones.”

Four hospice organizations intent on CMS reversing the SFP algorithm offered this:

“Over the past two years, the national hospice associations have presented CMS — in letters, in-person meetings and via other channels — with a wide array of research and well-supported advocacy outlining our concerns. We’ve reiterated those concerns to the White House Office of Management and Budget and Domestic Policy Council as well. Nonetheless, CMS has opted to ignore our  feedback, along with concerns from congressional leaders dating as far back as 2021.”

To be fair, CMS offered thoughtful comments on both scores. For example, regarding the payment cut for home health agencies, CMS said the following: “We reprice the base payment rate based on actual behavior changes by HHAs, not on how the behavior changes impact HHA margins. In any event, CMS looked closely at our data to ensure the payment rate adequately covers the costs reported by HHAs, without creating unnecessary hardship to providers and maintaining access to quality services for all beneficiaries. Maintaining access is one of CMS’s priorities when making policy decisions. We do not intend to obstruct the provision of home health services to any beneficiary who qualifies for this benefit.”

So, where to go from here? Both home health and hospice have appealed to Congress for help. Given the slow workings of this body, it is a bit of cold comfort. The sad reality is, like Dorothy and her friends, providers may be on their own.

Liza Berger is editor of McKnight’s Home Care. Email her at [email protected].