The U.S. Centers for Medicare and Medicaid Services’ (CMS) proposed home health payment rule came out in late June. The public comment period closes Friday, which means providers are running out of time to voice their concerns.
Overall, providers seem to be generally happy about the proposed rule, which includes a 1.7% — or $310 million — payment bump, as well as a nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) model for 2022.
Providers’ comfort with the rule is represented in the lack of public comments — just 32 as of Thursday. But among the comments are plenty of concerns and recommendations for CMS ahead of its decision on the final rule.
“We recognize that crafting the updates to the payment process amid a public health emergency is a daunting task and commend CMS for the effort in developing the proposed rule,” a commenter from Trinity Health At Home wrote to CMS. “Our comments and recommendations reflect a strong interest in public policies that support better health, better care and lower costs to ensure affordable, high quality and people-centered care for all.”
Based in Michigan, Trinity Health At Home is one of the largest home health providers in the country. Overall, the Trinity Health network includes 94 hospitals and 109 continuing care locations that include PACE, senior living facilities, and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually.
Trinity’s and others providers’ comments to CMS were extensive and wide-ranging, touching on subjects such as discrepancies in assumed and actual behavioral changes, the notice of admission (NOA) penalties, LUPA thresholds, Medicaid payment for home health and HHVBP.
The nationwide expansion of HHVBP
Trinity expressed its appreciation to CMS over the expansion of HHVBP and its belief in the model’s ability to generate cost savings. But the Trinity commenter also argued that the model — as currently constructed — is inherently unfair.
“This process often unfairly penalizes programs that provide cost savings to Medicare,” the person wrote. “The HHVBP program takes dollars from the bottom half of agencies and provides to the top half; this creates the potential for an endless loop where the higher scoring agencies are given funds to reinvest in outcome performance, which would suggest future improvements. Meanwhile, the lower half agencies would continue to be penalized even if they continue to produce savings for the Medicare program. This seems inherently unfair.”
The commenter pointed out that an agency in the 45th percentile of performers may differ barely from one in the 55th percentile. Still, the one in the 45th percentile would be subject to a penalty based on the HHVBP outline.
“[We] strongly recommend the model be constructed where the high performing agencies share in the Medicare savings, while those that do not meet this threshold are not penalized,” the Trinity commenter said.
HHVBP has been active in nine demonstration states since 2016. Under the proposed rule’s expansion plan, providers would compete on several performance measures against peers across the country for a maximum bonus — or penalty — of 5%.
If finalized, the proposed rule would do away with 2020 entirely, and 2019 — instead of 2015 — would become HHVBP’s baseline year.
Providers already involved in HHVBP since 2016 see a problem with that.
“We are requesting that CMS continue with the HHVBP payment adjustment for the final year CY-2022,” an anonymous commenter wrote. “Our teams have worked hard throughout the demonstration and would like to have the payment adjustment count for the final year of the demonstration according to the HHVBP original rule.”
Comments of note
More comments not relating to HHVBP came from other anonymous agencies.
“Please consider the following,” a clinical manager of a home health agency pleaded. “Please make public health emergency statutes permanent. Make OTs fully able to certify home health.
Take away the 14-day home health aide supervisory visit permanently. Take away the 30-day therapy reassessment, as it is no longer needed since we no longer count therapy visits. … COVID has continued to affect our agency on every level- especially staffing and revenue.”
A handful of additional commenters argued that occupational therapists (OTs) should be able to fully certify home health permanently moving forward.
“CMS needs to make the changes to continue allowing OT to conduct the initial assessment,” another comment read. “The country is facing a nursing shortage and providing services in a timely manner is a huge aspect of preventing hospitalizations. If CMS truly wants to follow the developed ‘Triple Aim,’ then skilled services need to be recognized. … Occupational therapy is just as important as every other skilled service that [agencies] provide and this policy needs to be brought into today’s world.”
Another commenter took issue with the NOAs, or at least expressed confusion over some of the provisions in the proposed rule.
“It states that agencies with patients who have a continuation of care from CY-2021 to CY-2022 will need to submit an ‘artificial NOA date’ at the beginning of the first 60-day episode in 2022,” the commenter wrote. “If HHVBP is finalized for implementation in CY-2022, will this be the requirement for existing Medicare patients? If so, will there be a timeframe for submission and — or — a late penalty of the artificial NOA date?”
Companies featured in this article:
Centers for Medicare & Medicaid Services (CMS), CMS, Trinity Health at Home
