‘Most Intense Advocacy Effort Of My Lifetime’: Home Health Industry Braces For Rate Cuts

Any day now, the home health final payment rule will officially be released by the Centers for Medicare & Medicaid Services (CMS).

As providers await its arrival, many of them are gathered in St. Louis at the National Association for Home Care and Hospice’s (NAHC) annual conference. If the final rule is as bad – or close to as bad – as the proposed rule, it will be a dark day for the industry.

It won’t be due to a lack of effort, however.


The main thing we’re looking at is the rate reduction of 7.69% – will it happen or not?” NAHC President William A. Dombi said at the conference Sunday. “We have been engaged in the most intense advocacy effort I’ve experienced in my lifetime. And I’ve been around a few years advocating. The effort that we have underway brings in all forms of advocacy.”

As opposed to past years where a certain provision may have been of concern for providers in the proposed rule, this year’s – if finalized as proposed – will threaten their very own existence.

Dombi noted that an estimated 51% of home health providers would be operating in the red if the rate reduction materialized for 2023, according to a NAHC analysis.


That number also assumes that agencies will not change the way they operate their businesses. Of course, they will have to if there is an aggregate 4.2% decrease to home health rates.

There is also some concern that the estimated 4.2% cut would be more severe than CMS is letting on.

“First of all, just that aggregate impact,” Scott Pattillo, chief strategy officer at Homecare Homebase, told Home Health Care News earlier this month. “CMS predicted that this year’s proposed rule would result in a 4.2% cut to the industry. In all of our aggregate models, using 36% of the data – which we think is a pretty good representative sample – we’re seeing a 5% cut to reimbursement. It is going to create an even greater impact on access to care.”

The prospects of that is why NAHC and others have taken that three-pronged approach to advocacy: the regulatory front, with Congress on the Preserving Access to Home Health Act and readying for a legal battle for when the rule is finalized.

Dombi also noted that there is significant support for the home health industry in its fight against rate cuts in Washington, D.C. That support is on both sides of the aisle, and in both Congress and the Senate. 

“Our allies in Congress have stepped up beyond anything I’ve ever experienced,” Dombi said.

Though a proverbial dark cloud was hovering during the speech, the preparation and advocacy that the industry has taken has given Dombi and other leaders hope as the final rule nears.

“The CMS administrator has probably had conversations ad nauseam at this point with members of Congress, with us and with many others,” Dombi said. “We are on the edge of our seats waiting to see what happens. If we give a blind prognosis, the prognosis is that we think we’re in the game. We have a meeting scheduled as late as Thursday of this week with the director of the Office of Management and Budget. They wouldn’t give us that meeting if they didn’t want to hear again what we had to say.”

The aforementioned legal battle would come after a negative final rule was finalized and possibly even after those rates become implemented in 2023.

Given recent success from hospitals on fighting a rate cut in court – along with other general legal trends in the U.S. – home health leaders are right to think they would have a strong case against CMS and the U.S. Department of Health and Human Services.

“We always look at litigation as a last resort,” Dombi said. “At the moment, we have thoroughly prepared the legal arguments presented both on the regulatory front and to Congress along the way, and we will do everything we can to protect your interest. The one thing I believe this advocacy staff does as well as anybody, if not better than anybody else, is they don’t give up — and you don’t give up either. So we look forward to teaming with you to the extent that we need to on a going-forward basis.”

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