Though home health providers await Medicare reimbursement cuts in the soon-to-be-released home health proposed rule, the support of key leaders in Washington is buoying their hopes for more moderate rulemaking.
“We have an aging population and people want to stay in their homes,” Joanne Cunningham, chief executive of the Partnership for Quality Home Healthcare, told McKnight’s Home Care Daily Pulse on Friday. “I would say, policymakers — congresspeople — understand that and echo that.”
Sens. Debbie Stabenow (D-MI) and Susan Collins (R-ME) earned providers’ respect last June with the reintroduction of the “Preserving Access to Home Health Act of 2023” to shield providers from steep, repeated Medicare reimbursement cuts. More recently, the two senators sent a letter to the Centers for Medicare & Medicaid Services raising concerns that the cuts have threatened beneficiaries’ access to home health services. They urged CMS to keep home health providers and patients in mind when determining Medicare rate adjustments for 2025.
“We appreciate CMS’s commitment to helping people get the care they need, where they need it,” Stabenow and Collins wrote in the letter sent last week. “This must include home health services for people with Medicare. As CMS proceeds to develop Medicare home health payment rates for 2025, we urge you to consider the value home health care provides to the Medicare program and its beneficiaries.”
Cunningham and PQHH applauded the senators’ comments, describing Stabenow and Collins as “true champions for Medicare home health” in a Friday statement.
And there are other home health supporters in Congress. Though Stabenow and Collins have “been with the home health community every step of the way,” Cunningham said, their tenure as lawmakers will not last forever. Thankfully, preserving home health access seems to be a popular priority in Washington, Cunningham noted.
“One of the things that I’ve noticed over the course of doing this work is how much policymakers care about care in the home, and care about supporting the ability of their constituents to access care in the home,” Cunningham said. “We just have to make sure that the home health voices are loud and continue to ask for needed attention and solutions.”
Despite the support from these policymakers, home health providers have still struggled under the multiple years of cuts. CMS applied temporary payment rate reductions of 3.925% and 2.89% in 2023 and 2024, respectively.
Permanent behavioral adjustments
“What [CMS has] effectively done since 2020 is rebase the rates and, and essentially, you know, instituted very sizable cuts to the program,” Cunningham said. “Our response to that is deep, deep concern and worry about the future of the Medicare home health program.”
A sense of pessimism hangs over the industry in advance of the proposed rule. Nobody knows what CMS will propose in any future home health rulemaking, but given its track record, it is unlikely to bring positive results, according to Cunningham.
“I think that the expectation is that CMS is going to continue in the rulemaking process down the same path of instituting permanent adjustments,” she said. “We don’t know the timing or when they would institute the temporary adjustments, but we’re mindful of those looming cuts that CMS highlights in the rulemaking process. And so the only question is, you know, ‘When is the axe going to fall?’”
Temporary rate cuts on horizon
She added that the possibility of CMS enacting billions in temporary behavioral adjustments in the upcoming proposed rule has made an impact.
“They’re looming, they’re concerning … they’re causing instability,” she said. “If you’re a provider and you see sort of this looming and growing billions and billions of dollars of clawback cuts in the form of these temporary adjustments, how do you plan your business? How do you think about building your organization to care for beneficiaries, not just for right now, but in the future?”
Providers have staged a multipronged front against Medicare cuts. In July, the National Association for Home Care & Hospice sued CMS, challenging the way it calculated budget neutrality adjustments for home health under the Patient-Driven Groupings Model. The case was thrown out last week due to administrative issues, but NAHC said the fight is not over yet.
