As home health grapples with another year of permanent Medicare payment cuts related to the Patient-Driven Groupings Model, advocates are anxious for passage of the Preserving Access to Home Health Act of 2023 this year.
“I don’t think I’ve said it this emphatically before. We must see this legislation passed,” Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare, told the audience at the Home Care 100 conference at the Fairmont Scottsdale Princess hotel in Scottsdale, AZ, on Monday.
She offered a blunt assessment of home health without action. The bill, which the Senate and House introduced last summer, would stop the Centers for Medicare & Medicaid Services from enacting any home health cuts.
The Medicare payment system faces a “very gloomy doomy future” if CMS’ current course does not change, Cunningham said.
She noted that, thanks to the PDGM payment policy, CMS has a “very nefarious” ability to do a recalculation of the permanent behavioral adjustment.
“When they recalculate, surprise, surprise, it gets worse,” she commented.
Besides the permanent behavioral adjustment of -2.89%, which went into effect in 2024, the industry is bracing for an upcoming so-called temporary behavioral adjustment reduction of up to $5 billion.
“All those things need to be wiped away,” Cunningham said.
In addition to blocking Medicare cuts, the legislation would require the Medicare Payment Advisory Commission, which advises Congress on Medicare payment matters, to conduct a better analysis of the home health payment environment, taking into account how Medicare, Medicaid and Medicare Advantage provide varying rates.
Also in play to counteract the Medicare reduction is a lawsuit filed by the National Association for Home Care & Hospice in July, Cunningham noted. The lawsuit argues that the 2023 home health final rule violated the law. In December, the administration urged a federal judge to throw out the lawsuit.
Other advocacy issues the Partnership is focusing on are holding Medicare Advantage accountable for rates and fair prior authorization rules.
Whether it is fee-for-service Medicare or MA, “you should get the same benefit you are entitled to under the law,” Cunningham said.
To be successful in advocacy in Washington, DC, repetition is key, Cunningham advised. And “an army of voices is key,” she noted.