CMS Punts on Sought-After Home Health Changes for ACOs

In its issuance of the final rule on Accountable Care Organizations (ACOs) and its Medicare Shared Savings Program, The Centers for Medicare & Medicaid Services (CMS) left home health stakeholders still seeking more changes that they say would better serve both patients and providers. 

The CMS rule, announced last week and to be finalized in the Federal Register Tuesday, gives providers under Medicare Shared Savings Program ACOs new options for risk sharing and relief from certain program requirements. It essentially provides greater risk options and greater rewards, in turn, for those that successfully measure savings under the program. 

Namely, participants are encouraged to transition to a two-sided risk model used by only 1% of 404 established ACOs currently. 

Home health stakeholders had hoped CMS would allow more ACOs to waive requirements, allowing people who are not homebound to receive home health benefits; however, the new final rule did not accommodate that change. 

National advocacy organization LeadingAge pointed to the lack of waivers for home health regulations in its response to the final rule. 

“Aspects of the proposed rule with most interest for post-acute care providers – waivers of certain regulations such as 3-day hospital stay, homebound status for home health, use of telehealth, and referrals to specific post -acute care providers – were largely left unaddressed in the Final Rule,” said Senior Vice President of Advocacy and Policy Dr. Cheryl Phillips. “With the exception of the 3-day hospital stay, CMS deferred flexibility on all other regulations for future consideration.”

In the rule making, CMS said it will consider the rule further, including potential future changes based on “lessons learned” regarding the waivers being tested. 

“We need additional time to assess whether any of the waivers discussed in the proposed rule or suggested by commenters are necessary for the operation of the Shared Savings Program,” CMS writes in the rule making. “We intend to consider this issue further and will carefully examine lessons learned regarding the waivers that are being tested as part of Innovation Center models and in the event that we determine that additional waivers are necessary to carry out the Shared Savings Program, we will propose them in future rulemaking.”

Written by Elizabeth Ecker