Racing against a deadline to comment on the Centers for Medicare and Medicaid Services’ proposed home health rule, three major groups representing home health agencies, the National Association for Home Care & Hospice, LeadingAge and the Partnership for Quality Home Healthcare, submitted formal letters protesting the rule Tuesday.
NAHC asked CMS to withdraw its proposed 2023 home health rule in a nearly 50-page letter to CMS Administrator Chiquita Brooks-LaSure. President William Dombi disputed the “validity and logic” of the proposed 7.69% payment reduction and CMS’s plan to claw back $2 billion in overpayments to home health providers. He questioned the methodology CMS used in calculating the rate cut and asked it to present a “comprehensive legal analysis of its obligations under Section 1895 of the Social Security Act” before initiating any rate adjustment.
CMS used a “fatally flawed methodology” that “applies the HHRG-HHPPS payment system to the PDGM-induced 2020 home healthcare delivery, a universe that would not exist in the absence of PDGM,” NAHC said in its comments. [HHRG-HHPPS, or Home Health Resource Groups-Home Health Prospective Payment System, is the old payment model; PDGM, or Patient-Driven Groupings Model, is the current payment model.]
Dombi told McKnight’s Home Care Daily Pulse an analysis that NAHC has conducted concluded CMS should actually be increasing rates to home health providers, rather than cutting them.
“In using the same methodology that CMS employed to create the rate, we come to the conclusion that the home health agencies have been underpaid and depending upon which methodology you use … we see an underpayment ranging from 2.5% to 3.2%,” Dombi asserted.
Dombi estimates more than half of home health agencies could be at financial risk if the rule goes into effect. While he said that might not translate into actual business closures, it could result in thousands of Medicare recipients losing home health services.
“You’re likely to see the first victims being the beneficiaries themselves,” Dombi explained. “A home health agency says I’m going to narrow my territory or they may focus their admissions on certain kinds of patients.”
In a separate letter to Brooks-LaSure, LeadingAge also raised the specter of thousands of older Americans potentially losing home healthcare and called the rule a reversal in the Biden administration’s commitment to home-and-community-based services.
“On the one hand, the Biden Administration has consistently and publicly promoted its commitment to ensuring older Americans’ access to quality aging services — with an emphasis on care in the home and community,” Katie Smith Sloan, LeadingAge president and CEO, said in a statement. “Yet in its actions, the administration is undermining providers’ ability to deliver these critical services, just as it did with nursing homes, CMS is unfairly assuming all providers are bad actors. This is not acceptable.”
LeadingAge called on CMS to delay the payment cuts for at least one year.
Legislation that would delay the proposed rule from going into effect until 2026 is now pending in both houses of Congress. Dombi said NAHC is working aggressively on Capitol Hill to get a bill passed and to President Biden by late September, before CMS is expected to release the final home health rule in late October or early November.
The proposal has been a magnet for criticism since CMS announced it nearly two months ago. Humana estimated the payment cut could cost it up to $30 million. Home care giant Amedisys said in late June it was temporarily halting home health acquisitions until it had better guidance on how a cut in Medicare payment rates might impact its business.
