[Updated] House Lawmakers Include HHGM in Proposed Spending Bill

House lawmakers approved a new spending bill to keep the federal government running that included several home health provisions, notably the reintroduction of a controversial overhaul to the Medicare payment system known as the home health groupings model (HHGM).

HHGM was first floated in the proposed rule setting 2018 Medicare payment rates for home health, but after fierce industry backlash, was left out of the final version of that rule, released in November. However, there were indications that HHGM might return.

The draft bill is a short-term budget plan from Congressional Republicans funds the federal government through March 23, 2018, and funds the military for a full year. The bill’s trajectory in the Senate was less clear Tuesday night. Lawmakers must strike some sort of budget deal and pass legislation by Feb. 9 to avoid another short-term government shutdown, like the one that occurred last month.


Section 2201 of the bill calls for home health payment reform similar to HHGM, notably the transition to a 30-day unit of payment for home health services, to be effective starting in 2020. Currently, providers are reimbursed in 60-day units. Unlike the original HHGM proposal, this one calls for implementation to be budget-neutral. When the Centers for Medicare & Medicaid Services (CMS) first introduced the HHGM framework last year, it estimated that it would result in an overall $950 million payment cut for providers if implemented in a non-budget neutral manner and about a $480 million cut if implemented in a partially budget-neutral manner.

Home health provider association ElevatingHome is “disappointed” that HHGM is included in the CR language, Joy Cameron, the organization’s vice president of policy and innovation, told Home Health Care News.

“While we appreciate the modification of budget neutrality, there is still a great deal of work to be done on the model,” Cameron said. “On February 1st, Abt held a technical advisory panel on HHGM, and there were many questions raised for consideration and more analysis that needs to be done. When we reached out to Congress to get assistance in stopping HHGM, the industry promised to work with CMS on a new process and proposal and we have been doing that. To set an artificial start date is unnecessary and does not sync with the ability to assess impact on patients, quality outcomes and providers prior to implementation.”


The association is committed to “honoring its commitment” to work with CMS to develop the best version of the model possible, she added.

The House’s draft continuing resolution also includes a number of other Medicare-related items of keen interest to home health providers. These include the permanent repeal of therapy caps; an extension of the home health rural add-on through Oct. 2022; a provision allowing home health medical records to be used to determine eligibility for home health services; and the ability for home health providers to enter into a voluntary settlement with the Department of Health and Human Services over disputed Medicare claims, to help clear a backlog of appeals.

Written by Tim Mullaney

Editor’s note: This article has been updated from  previous version Congressional events unfolded Tuesday.

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