Home Health Experts Suggest Improvements to New Payment Model

A new payment model is coming to home health, and input from a recent technical expert panel (TEP) could indicate some top concerns from within the industry.

The TEP, which met February 1, 2018, will help the Centers for Medicare & Medicaid Services (CMS) shape the new prospective payment system (PPS) by offering its input over the next two years. Inclusion of the TEP was also mandated in the Bipartisan Budget Act of 2018, which included many home health provisions and was signed into law on Feb. 9, 2018.

However, the legislation mandated that this group meet at least once, and it’s unclear if the TEP will convene a second time, making the focus of its first meeting all the more crucial. The budget act was signed into law by President Trump on February 9, 2018, and funded the government for two years in addition to making several changes to the health care industry. Abt Associates has been chosen as the convener of the TEP.


TEP members included National Association for Home Care & Hospice (NAHC) President Bill Dombi and LeadingAge Director of HCBS Peter Notarstefano.

“Some of our concerns include the significant reduction in case mix weights that is applied to therapy episodes in the HHGM,” Notarstefano wrote in a follow-up post to the LeadingAge website. “We did not agree with the use of a therapy threshold for payment because it invites fraudulent behavior; but the HHGM as proposed negates the importance of therapy to reduce the incidence of falls, improve ambulation and promote independence for older adults in their own homes.”

Meeting highlights


The meeting focused on home health payment reform, according to available materials, with specific perspectives on the home health groupings model (HHGM), which was proposed in 2017 and not finalized.  HHGM threatened to cut $950 million in payments from the industry and would have significantly changed the payment system by grouping patients into categories.

The new model, which is slated for 2020 under the budget act, could have some similarities as HHGM, but comes with the caveat of being “budget neutral,” a significant sticking point. CMS received 1,347 total comments from stakeholders on the HHGM proposal last year, and the TEP summarized and discussed the feedback in its meeting, the materials disclose.

One major change discussed was also changing the 60-day episode to a “30-day period,” which would split an episode into equal payments for each 30-day period.

The meeting also took a hard look at possible case-mix adjustment models and analyzed the six clinical groupings proposed in HHGM. Some concerns included too much reliance on principal diagnosis and not enough therapy groups.

A recording of the meeting was not yet publicly available as of press time.

Written by Amy Baxter

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