HHGM Bill Would Delay But Not Halt Massive Medicare Cuts

A bill in the U.S. House of Representatives would delay implementation of the controversial Home Health Groupings Model (HHGM) until 2020, but industry advocates say it does not address fundamental concerns with HHGM, including that it could cause catastrophic payment reductions of up to $4 billion to providers.

Rep. Kristi Noem (R-South Dakota, pictured above) put forward the bill—the Rural Home Health Extension and Regulatory Relief Act (HR 3992)—last Friday, Oct. 6. It would push back the start of HHGM from the currently proposed date of Jan. 1, 2019, to Jan. 1, 2020.

First proposed in July 2017, HHGM would drastically change the way home health agencies are reimbursed through Medicare, including by changing the standard episode of care from 60 days to 30 days. The Centers for Medicare & Medicaid Services (CMS) initially estimated that HHGM would reduce Medicare payments to home health agencies by $480 million to $950 million in calendar year 2019.


The impact actually could be greater, according to an analysis from ElevatingHome, an Arlington, Virginia-based trade group representing home health providers nationwide. The analysis found that agencies would experience an average payment reduction of 17% rather than the 4.3% anticipated by CMS.

ElevatingHome quickly came out against Noem’s bill.

“HR 3992 … uses the same, untested formula and shift to a 30-day episode as found in the proposed HHS rule,” the group stated Friday.


The bill also does nothing to address the “larger concern” that  federal authorities are pushing forward with HHGM without proper testing or collaboration with the home health industry, ElevatingHome added.

One upside of the bill is that it would extend the add-on for rural home health providers for five years. But those financial gains would be drastically offset by the payment reductions that providers in both rural and urban areas would experience under the bill’s proposed formula of trimming 3.7% in reimbursements over four years through HHGM. ElevatingHome calculates that this would result in a total cut of $4 billion.

Rep. Noem’s office had not responded to voicemail and email inquiries from Home Health Care News as of press time.

Another large home health industry association, the National Association for Home Care & Hospice (NAHC) had not made any public statements regarding the bill as of Monday afternoon. However, it is drafting comments to the House Committee on Ways and Means about the legislation, NAHC told HHCN.

The bill is expected to be marked up by Ways and Means this week.

Written by Tim Mullaney

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