Home Health Advocates Step Up HHGM Fight in Nation’s Capital

In the wake of a controversial proposal to change the Medicare payment system, state and national home health and hospice associations are stepping up their fight against the new model.

The Home Health Groupings Model (HHGM) was introduced when the Centers for Medicare & Medicaid Services (CMS) issued its proposed prospective payment system (PPS) rate update for 2018 at the end of July. Most notably, the HHGM proposal could result in a $950 million payment cut to the sector and change the current 60-day episode of care unit of payment to a 30-day period.

Industry associations, providers and other stakeholders engaged with leadership at the federal and state level last week in Washington, D.C., with hundreds of representatives from the industry making their voices known, including meeting with Congressional delegations and leadership from CMS.


Lobbying Push

Home health participants represented the industry in a policy summit in D.C. hosted by the Council of State Home Care Agencies, which represents 15,000 agencies across 38 states. The day brought together CMS representatives, members of the Trump administration and home health care agencies.

While the summit covered hospice, Medicaid and behavorial health services, home health care was front and center, with the groupings model looming on everyone’s minds, Tim Rogers, chair of the Council, told Home Health Care News. Rogers, who called the event a “grand slam home run,” was optimistic about the impact left with policymakers and regulatory agents.


The model represents “drastic draconian negative impacts on how it redistributes revenue and unevenly handles payments across the system,” Rogers told HHCN. “It’s really geared on inefficiency and not high-quality outcomes.”

At the same time, the National Association for Home Care & Hospice (NAHC) was working on its agenda to push back hard on the PPS and groupings model.

“We met with the health policy counsel to Secretary Price and expressed our concerns with the HHGM,” Bill Dombi, interim president of NAHC, told Home Health Care News. “Specifically, we raised why a non-budget neutral transition to an untested model is bad health policy. In addition, we raised serious concerns that HHGM is not ready for prime time in 2019 as there needs to be a public disclosure of numerous data elements, especially what is behind the undefined ‘behavioral adjustment.’”

Dombi also reiterated in the meeting that the home health care industry is willing to work with CMS on modernizing the payment system, but input and collaboration is necessary.

“Finally, we expressed that the home care community is ready, willing, and able to work constructively with CMS to develop a modernized payment model on an accelerated basis,” Dombi said.

However, CMS didn’t reveal much on where it was leaning, Dombi said.

“In a rulemaking process, HHS/CMS cannot really talk,” Dombi told HHCN. “They are confined to listening and raising some questions.”

NAHC, working with the Partnership for Quality Home Healthcare, made public comments in a letter to CMS Administrator Seema Verma supporting efforts to modernize the system, but asked for the proposed 2019 model to be withdrawn, “as we require additional information in order to fully assess the impact of the proposed rule,” the letter reads. They also submitted several questions requesting more information about the impact of the specifics of the proposal.

The comments were signed by Keith Myers, chairman of the partnership and CEO of LHC Group (Nasdaq: LHCG), and Dombi.

The proposal is listed on the Federal Register with a public comment period ending September 25, 2017. The home health care industry has already left more than 85 comments as of September 15, and 77 could be publicly viewed. Comments largely focused on concerns regarding the major restructuring that CMS proposes, with responses coming from physical therapists, nurses and other stakeholders.

Written by Amy Baxter

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