New Home Health Payment Reform Moves Closer to Reality

Fast-moving developments on Capitol Hill are all but ensuring that home health care payment reform will be going forward.

After the House of Representatives approved a short-term spending bill on Tuesday to fund the government, the Senate introduced its own version Wednesday. Both bills include major health care measures.

Among the biggest changes is a new, 30-day payment model for home health care in 2020, replacing the current 60-day unit. The reappearance of this language follows the defeat of a similar proposal last year—the home health groupings model (HHGM)—which was ultimately not finalized by the Centers for Medicare & Medicaid Services (CMS).


At this point, the impact of a 30-day payment model on the industry is “impossible” to tell, as the measure has not yet been approved by both houses of Congress and the specifics would be worked out in a future proposal from CMS, according to Bill Dombi, president of the National Association for Home Care & Hospice (NAHC).

However, there is some good news for home health care providers, as the legislation requires the proposal to be budget neutral, unlike HHGM.

Next steps


While the House passed a short-term spending agreement with the measures Tuesday, it was unclear if both houses would approve a bill before government funding ran out Thursday at midnight. As of Wednesday afternoon, Senate leaders in both parties announced agreement over their two-year spending plan, but no vote had taken place on the floor. The Senate’s draft version of its spending bill included identical measures related to home health care services.

California Representative Nancy Pelosi, the House Democratic leader, said Wednesday she and other Democrats will oppose a deal to fund the government unless a guaranteed vote for DACA—Deferred Action for Childhood Arrivals—recipients is on the table. Her speech on the House floor Wednesday in defense of these immigrants, which number roughly 800,000 “dreamers,” ran longer than any State of the Union address in history, the Independent reported. She was still speaking as of press time.

As the two Congressional chambers grapple over an agreement, home health care leaders are advocating for some tweaks to the reforms and measures. A technical expert panel has been working with the legislature and CMS on coming up with payment reform measures, according to Dombi. After the panel met last week, it was not decided if it would meet again.

“The first next step is getting the Senate to tweak things,” Dombi said Wednesday morning.”What we would expect to see is continued dialogue regarding the model itself. That can happen within and outside the technical expert panel.”

In addition, HHCN knows of at least one CEO of a large home health provider company who flew to Washington, D.C., Tuesday night in light of the news of the bill’s passage in the House.

If a bill is approved in the Senate with the home health payment reform attached, CMS will likely propose a full model, or regulations pertaining to the payment reform, within its 2019 proposed rule, to come in summer 2018.

“With the 2020 mandate in the House bill, if that’s where it ends up [in the Senate bill], we expect CMS to come up with a proposed model in the 2019 proposed rule for a one-year lead time for implementing any new model,” Dombi said. “The next few months will be a big tell as to what we will expect, and the next step will be dialogue.”

NAHC is advocating to push back the 2020 timeline—or, at least, to change the language so that the model could be implemented “no earlier than 2020,” Dombi said.

“The technical expert panel left CMS with an impression that the proposal for 2019 isn’t ready for primetime,” Dombi said. “Unless they have an alternative in their pocket, it’s likely they won’t have something ready for 2020, too.”

HHGM differentiation

When HHGM was taken off the table for 2019 implementation, it was clear that regulators and legislators were still keen on putting forth home health payment reform, and the industry was likely to have a louder voice in the process. Since then, amid ongoing reform efforts, the technical expert panel of industry associations and stakeholders has helped drive the dialogue.

“Developments on the Hill related to the legislation are moving rapidly,” Keith Myers, chairman of the Partnership for Quality Home Healthcare and CEO of LHC Group (Nasdaq: LHCG), said in a statement. “The Partnership is continuing to review the legislation under consideration to more fully understand the proposed policy changes and their impact on patient care. We hope the final bill will include home health policies that ensure patient access to quality home health services.”

One of the biggest differentiators from the original HHGM proposal is that the House legislation includes a budget neutrality requirement, according to Joy Cameron, vice president of policy and innovation at industry association ElevatingHome.

However, “significant testing and analysis” remains for the new proposed model, she told Home Health Care News Wednesday.

The legislation offers more protections compared to the regulations proposed last year.

“What is accomplished in the language is a degree of predictability and security that we have, than if everything were left to CMS,” Dombi told HHCN. “This now requires them to propose a budget neutral [model]. At least we have that guarantee that if there is something, it has to be budget neutral.”

HHGM, as it was proposed last year, was anticipated to cut approximately $950 million in payments if implemented in a non-budget neutral manner.

In addition, the legislation does not include the same behavioral adjustments as HHGM did, Dombi added.

“This doesn’t put us in the position of saying how much hurt versus help [for providers]. That’s a long way off, but it puts some guardrails around the hurt, harm and unpredictability, and around security,” Dombi said. “No doubt there is good news.”

Written by Amy Baxter

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