National Association for Home Care & Hospice President William Dombi issued a frank assessment of the state of home healthcare Thursday in advance of the release of the Centers for Medicare and Medicaid Services’ proposed payment rule for 2024.
“There is intense congressional action going on,” he said Thursday in a webinar hosted by the Polsinelli law firm. “Regulatory response is in play. Even litigation is on the agenda as well. This is the equivalent of a Medicare home health war at this point in time.”
NAHC and other associations are anticipating a rate cut in the proposed rule.
“We’re days away from seeing the proposed payment rule for 2024,” he said. “There’s a lot we’re watching for there with potential for a proposed rate cut that ranges from low single digits to mid teens [that would] really be putting the delivery of care in jeopardy.”
The permanent behavioral adjustment of -3.925%, which went into effect this year, has contributed to staffing shortages, which have resulted in a drop in hospital-to-home health conversion rates, he told McKnight’s Home Care Daily Pulse earlier. A temporary rate adjustment — so-called clawback payments related to the Patient-Driven Groupings Model — also could surface in the proposed rule. It could total billions of dollars.
Medicaid access rules
Home care already is dealing with the aftermath of two other significant rules from CMS proposed in April.
Ensuring Access to Medicaid Services (Access NPRM) and Managed Care Access, Finance, and Quality (Managed Care NPRM) would require home- and community-based services (HCBS) to publish average hourly rates paid to direct care workers and strengthen person-centered service planning, among other provisions. Perhaps the most controversial requirement is that 80% of Medicaid payments for personal care, homemaker and home health aide services be spent on compensation for direct care workers.
“Essentially, the states would report data each year on the proportion of the total amount of Medicaid expenditures they had for these three services and the proportion of that that was provided to the workers,” NAHC Director of Medicaid HCBS Damon Terzaghi explained Thursday.
Providers have voiced their displeasure with this measure. Last week, Addus HomeCare CEO Dirk Allison noted that the rules would “disproportionately” affect caregivers in states that pay them less and put “a vast majority of the small mom-and-pops” out of business.
Terzaghi expressed frustration that the 80/20 measure is distracting from the other positive provisions within the text.
“We’re partially frustrated about this 80/20 proposal not just because of the challenging policy and, we think, the unsupported mandate they’re putting on providers, but also because it’s sucking the oxygen out of the room for so many potentially positive changes that were included in this regulation,” he said.
Angelo Spinola, Polsinelli’s home health, home care and hospice chair, pointed out to providers that the rules are not yet final and that there is an open comment period until July 3. He also noted that associations and providers are working on issuing statements.
“This is one of those areas where a loud and uniform voice is going to make a significant difference,” he said. “This isn’t going to be a one-and-done type of situation. The rule would not actually go into effect until four years after the final publication.”
