If I were a lobbyist trying to soften the Centers for Medicare & Medicaid Services’ (CMS’) proposed home health rule, I’d be feeling a little more confident right now. Two reasons: The hospice final rule and the skilled nursing facility final rule.

In both instances, CMS modified its position pretty significantly between the proposal and final stage. In the case of the hospice final rule, CMS increased the Medicare funding update by more than a percentage point  — from 2.7% to 3.8%.

Perhaps of even more relevance to home health providers is the recent SNF final rule, which gave providers a 2.7% increase, or approximately $904 million more, for FY 2023. It also, perhaps more importantly, included a two-year phase in of a Patient-Driven Groupings Model (PDGM) parity adjustment. That was after CMS issued its proposed rule, which sought to pull back 4.6% in payments from providers related to the PDGM adjustment. This move (surprise! surprise!) resulted in a deluge of comments in protest.

Hospice rule criticisms

To be sure, neither of these two rules was perfect. Respective providers still cried foul about the updates given the current environment of wage pressures, inflation and an intense workforce shortage. Speaking to me recently, Theresa Forster, VP for hospice policy at the National Association for Home Care & Hospice, also said she was disappointed that CMS did not include a budget-neutral 5% cap on wage-index decreases for hospices in FY 2022, as it did for inpatient hospital payments.

“They really should look at other providers whose wage indexes are based on the hospitals or are mostly aligned and extend the same protections to other providers,” she said. “We’re pretty far down the food chain. We have a hard time competing for staff and buying at the same bulk rate that other systems can. We’d like to have the same consideration when it comes to the [same] kinds of changes.”

But all in all, the hospice Medicare update was positive, she said.

It “won’t take care of all the financial concerns hospices have, but it will help,” she said during a NAHC webinar Wednesday.

SNF perspective

Meanwhile, while SNF providers certainly were relieved by the higher payments, they still were concerned about the final rule. Specifically, they did not like CMS’ inclusion of a two-year 2.3% decrease related to the PDGM parity adjustment to account for unintentional overpayments. Some had been hoping for a three-year phase-in; others  wanted it omitted altogether. 

“We warned CMS that this is not the time to cut payments,” LeadingAge President and CEO Katie Smith Sloan said in a statement following the final rule. “Spreading the impact of the adjustment over two years (2.3% in FY 2023 and 2.3% in FY 2024) is helpful, but the end result adds to the chronic financial neglect of our nations’ nursing homes — in a time of real crisis.”

When asked about CMS’ change of direction on the hospice and SNF rules, Bill Dombi, president of NAHC, said the agency was simply basing its final update determinations on new data. And unlike SNFs, home health agencies are not looking for a phase-in related to the Patient-Driven Groupings Model behavioral adjustment; they are looking for a different methodology to calculate budget neutrality. 

Still, Dombi, who is single-minded in his intent to try to reverse the course of the home health proposed rule, acknowledged that the final rules for hospice and SNFs bode well for his industry — to a point.  

“Will we get all of what we think we need to be fair, we’ll have to see,” he told me. “That’s why we have legislation pending.”

Liza Berger is editor of McKnight’s Home Care. Email her at [email protected].