A new bill that would prevent the U.S. Centers for Medicare & Medicaid Services (CMS) from reducing home health payments this year – and until 2026 – was introduced in the Senate Monday afternoon.
Dubbed The Preserving Access to Home Health Act, the bill was introduced by Sens. Debbie Stabenow (D-Mich.) and Susan Collins (R-Maine), both of whom have been longtime advocates of at-home care.
“The bill is set up so that CMS is blocked from reducing payment rates until 2026,” National Association for Home Care & Hospice (NAHC) President William A. Dombi told Home Health Care News. “And the purpose of that, essentially, is to create what we hope is an opportunity to correct where CMS is at in terms of their methodology. And to deal with even some of the questions around transparency relative to the data that we’ve asked for.”
The bill would also “ensure that any adjustments CMS determines to be necessary to offset increases or decreases in estimated aggregate expenditures are made by 2032, such that no cuts would be delayed beyond the end of the budget window,” according to the Partnership for Quality Home Healthcare (PQHH).
Additionally, it is set up to be a piece of legislation that comes with “zero cost” to the system, which Dombi thinks bodes well for its chances.
The news was welcomed by home health providers with glee on Monday, but there is still much work to be done for the bill to be implemented. The next step would be for an identical bill to be introduced in the House, which Dombi hopes will happen later this week.
*Editor’s Note: The House introduced an identical bill on Thursday.
After that, the home health industry is counting on all of its members to engage in a true grassroots efforts to get more lawmakers involved in supporting the act, particularly during the recess period when they are back in their respective states. Tentatively, that would be between Aug. 8 and Labor Day.
But the goal is to have enough done from an advocacy standpoint by mid-August so that CMS is not already writing a final rule by the time enough momentum is gained.
“The recess period is going to be filled with our grassroots efforts,” Dombi said. “So we do hope that by the time they return after Labor Day, there will be – in waiting – dozens of senators and maybe even hundreds of members of the House [behind this]. People may say that’s wishful thinking. But you have to go into this with a goal. And that’s our goal.”
Dombi compared this effort to the one in 2017 when CMS attempted to change the home health payment system to something called the Home Health Groupings Model. The support that NAHC was able to garner to knock that down then has given advocates the confidence that things will work out for them this time around as well.
He also mentioned that NAHC was not putting all its eggs in one basket. It is going to continue pushing CMS on a regulatory level, while also looking at the proposed rule from a legal level, though the latter could take a lot longer to come to fruition.
For context, NAHC said that – according to its own analysis – 44% of agencies would be operating with negative margins if the current proposed payment rule were to go into effect in 2023.
“So, 40% of the providers will go into a negative margin if the [rule holds],” Ken Albert, the CEO of the Maine-based Androscoggin Home Healthcare + Hospice, said on a panel at NAHC’s Financial Management Conference Monday. “This isn’t about some whining and complaining about having a little less in our pockets. This is about access to quality home health care.”
CMS proposed rule – first released on June 17 – would include a 4.2% decrease to aggregate home health payments, or $810 million less than 2022. The agency is also trying to clawback more than $2 billion from the sector as soon as 2024.
Many disagreements are on the table right now between the home health industry and CMS. But the fundamental one is “budget neutrality.” Broadly, when a payment system changes in Medicare, it needs to be budget neutral compared to the prior one.
If the two sides agree on anything, its that the Patient-Driven Groupings Model (PDGM) has not been budget neutral. The issue is that one side thinks home health providers have been paid far too much for their services, while the other believes the opposite.
“I would like to thank Sens. Debbie Stabenow and Susan Collins for their long-standing support for Medicare beneficiaries receiving high-quality home health care,” AccentCare CEO Steve Rodgers said in a statement shared with HHCN. “By introducing legislation requiring a pause in implementing the draconian cuts proposed in the FY 2023 payment rule, this will give CMS time to release the data being utilized to calculate payments under PDGM, ensuring that there is transparency around the agency’s methodology in calculating the home health base payment rate.”
The ultimate goal is to keep home health providers afloat – without dealing with a negative adjustment – until some sort of understanding between the sector and CMS can be reached.
“While we continue to educate CMS on the overall impacts of their proposed cuts, we commend lawmakers in Congress for proactively offering legislative solutions to these harmful payment adjustments,” Joanne Cunningham, the executive director of PQHH, also added in a statement.
Best- and worst-case scenarios
If the bill is passed, the best-case scenario is that the home health industry ends up winning the advocacy battle in the long-term, while also shielding itself from both negative reimbursement adjustments now, as well as further clawbacks from CMS down the road.
On the other hand, the worst-case scenario is that the bill becomes enacted, but CMS still finds its methodology justified by 2026. That, in turn, would mean that the home health sector would be under the pressure of all of the clawbacks that had mounted up over that time and had not been paid.
“If we are unable to convince CMS to come up with a different methodology, it would mean an accumulation of an overpayment,” Dombi said. “Whether it be one year or 10 years, CMS has the authority to do these adjustments in a time and manner that they deem appropriate. So it’s possible. And that’s the worst-case scenario, where they come back and they say, ‘Home health, you owe $10 billion, because you paused this whole thing.”
Still, at this point, Dombi does not think that is a likely scenario.
Lack of transparency
Earlier this month, a group of advocates converged on Washington, D.C., joining Dombi and Cunningham to ensure that this bill would be created.
The legwork had been done beforehand, and a final push was made by some of the largest names in the industry, including Albert and LHC Group Inc. (Nasdaq: LHCG) CEO Keith Myers.
Over and over on Monday, the word that kept coming up from both the advocates and executives that had made the trip was “transparency,” or the lack thereof from CMS during this whole process.
CMS has reportedly said that it does not need to release any more data – or look behind the curtain – in regards to its decision-making process right now, and that enough public data is available already.
Dombi, as well as most others in home health care, disagree.
“The transparency is an issue. As is the methodology that they chose to use. And part of that is the methodologies they chose not to use,” Dombi said. “So, we’re in the fight.”
Companies featured in this article:
Androscoggin Home Healthcare & Hospice, LHC Group Inc, National Association for Home Care & Hospice, Partnership for Quality Home Healthcare
