Close-up of Money and Flag.

In a win for home care providers, the new omnibus spending package, which Congress recently released, prevents across-the-board 4% Medicare cuts for 2023 and 2024, also known as the PAYGO reductions. It also extends telehealth provisions through the end of 2024 and requires that the Centers for Medicare & Medicaid Services provide transparency around how it arrives at rate cuts.

But the Consolidated Appropriations Act, 2023, which will fund the government through fiscal year 2023, does not postpone the 3.925% rate cut starting in January that was part of the home health final rule. Providers had been pushing for the inclusion of this delay in the bill.

The rule represents a “mixed bag” for home care providers, Tom Threlkeld, spokesman for the National Association for Home Care & Hospice, told McKnight’s Home Care Daily Pulse Tuesday. “There were some wins in there for us and some things we were hoping to avoid. Our advocacy on the home health rate cut isn’t done. In 2023 we’re going to focus on the economic model that works for home health providers and patients.”

LeadingAge was pleased with the rate cut transparency language in the bill, which mandates that the Department of Health and Human Services offer “publicly available information on the simulation of 60-day episodes under the Medicare home health prospective payment system in effect prior to the Patient-Driven Groupings Model.”

The legislation also requires that HHS use a public forum to engage with home health stakeholders on the home health payment rate development within 90 days of enactment.

“Having this data will allow for the comparison of behavior before and after the change to PDGM and enable providers to give CMS more accurate feedback on points of disagreement,” Mollie Gurian, vice president, home-based and HCBS policy for LeadingAge, said in a statement sent to McKnight’s Home Care Daily Pulse. “What’s more, the legislation also requires CMS to meet with stakeholders to receive feedback on rate development for CY2024 and to also release the applicable data in advance of that public meeting.”

She continued, “Even though this legislation will not impact the rates for CY2023, that Congress listened to our advocacy and took action to address our concerns is a positive — and we are hopeful that this will put us on the path to achieving a payment approach that works for our mission-driven, nonprofit members and guarantees that all older adults and their families can get needed care and services.”

Other provisions in the bill affecting home care providers include the following:

  • Extension of Acute Hospital Care at Home initiative through 2024
  • Extension of the 1% add-on payment through the end of 2023 to certain home health agencies that furnish services that furnish services in counties with a low population density
  • Extension of Medicaid Money Follows the Person Rebalancing demonstration at $450 million per year through fiscal year 2027
  • Extension of spousal improvement protections to 2027 against spousal impoverishment for recipients of home- and community-based services

Home medical equipment providers praised the congressional package, which also continues through the end of 2023 the 75/25 blended Medicare rate for non-CBA/non-rural home medical equipment suppliers.

“This is a major win for the home medical equipment community,” Tom Ryan, American Association for Homecare president & CEO, said in a statement. “The relief granted for non-rural/non-CBA suppliers, taken with the 50/50 blended rate in rural areas granted to rural suppliers by CMS in the 2021 DMEPOS Final Rule, will impact bottom lines for a large swath of the industry. Preventing potentially ruinous 4% PAYGO cuts on every single Medicare transaction for HME is obviously very consequential across our industry, as well.”

Beyond home health and personal care providers, the legislation offered some favorable provisions for hospice providers. These include the omission of a 20% hospice aggregate cap decrease.

This is a developing story. Please check back for updates.