Home care advocates blasted the Centers for Medicare & Medicaid Services’ final 2023 home health rule late Monday, despite it being less onerous than originally proposed.
The rule handed down late Monday afternoon provides a 0.7% increase in Medicare payments ($125 million) to home health agencies in 2023, instead of the 4.2% cut CMs proposed in June. However, the agency is also phasing in a behavioral adjustment. CMS will implement a 3.925% behavioral rate cut, a $635 million decrease, for calendar year 2023. This represents half of the full permanent adjustment of -7.85% (-7.69% in the proposed rule).
“We note that the overall impact of the -3.925% permanent behavioral assumption adjustment is -3.5%, as the permanent adjustment is only made to the 30-day payment rate and not the Low Utilization Payment Adjustment (LUPAs) per visit payment rates,” CMS said.
Provider advocates said the rule could have a devastating effect on home health agencies.
“The agency has made clear that future cuts and clawbacks are on the horizon,” LeadingAge President and CEO Katie Smith Sloan said in a statement. “The behavioral adjustment methodology CMS used is problematic, as explained in our Aug. 16 comments to CMS and we are concerned about its impact on our mission-driven, nonprofit providers.”
The Partnership for Quality Home Healthcare said the steep cut will have long-lasting effects on long-term care for millions of older adults. It noted that CMS also plans to apply additional “clawback cuts” of more than $2 billion for services provided to patients during the COVID-19 pandemic.
“This 7.85% cut is worse than initially proposed and when enacted in 2024, will result in an immediate decline in access to home health,” PQHH CEO Joanne Cunningham said in a statement. “This will have negative effects on the availability of care for the most chronically ill of the Medicare population and result in access to care problems.”
The National Association for Home Care & Hospice promised to make good on an earlier threat to seek relief from the cuts on Capitol Hill.
“We now turn to Congress to correct what CMS has done and prevent the impending harm to the 3.2 million highly vulnerable home health patients that depend on this essential Medicare benefit annually,” NAHC President Bill Dombi said in a statement. “Even with the limited phase-in of the rate cut, with significantly rising costs for staff, transportation and more, home health agencies across the country cannot withstand the impact of rate cuts.”
The Preserving Access to Home Health Act introduced last summer in the House and Senate would delay any Medicare cuts to home health until 2026.
Specific home care companies also weighed in on the rule Monday.
“The final rule should be viewed for what it is which is nothing more than CMS adjusting payments for home health services by applying post-2020 provider behaviors to pre-2020 reimbursement methods,” Stephan Rodgers, CEO of AccentCare, said in a statement. “Rather than ensuring the payment amounts are budget-neutral, CMS’s actions constitute an unauthorized rebasing of the home health payment amount, which will lead to patient access issues for the Medicare benefits they are entitled to under law.”
