What Home-Based Care Leaders Should Know About The $1.66 Trillion Spending Bill

The proposed $1.66 trillion omnibus government funding bill – which is expected to pass through the U.S. House and Senate this week – includes multiple home-based care provisions of importance.

Among those is new home health payment transparency language, an extension of the rural add-on, a separate extension of the Money Follows the Person program and more.

While home health and home care stakeholders will be pleased with some of what’s included in the omnibus spending bill, they will likely be at least partially disappointed that Congress did not postpone the 3.925% rate cut that was part of the home health final rule for 2023.


Providers had been pushing for that delay once the final rule was published. However, the payment rule will move forward as published.

One of the biggest wins for the home care industry is the absence of the 4% Medicare cuts across the board for 2023 and 2024, also known as the PAYGO reductions.

In March 2021, Congress passed the American Rescue Plan Act of 2021 (ARPA), a $1.9 trillion economic recovery package that included — among other things — a 10% increase to Federal Medicaid Assistance Percentage (FMAP) for home- and community-based services.


It also included $8.5 billion in Provider Relief Fund money for rural health care providers, including home health and hospice agencies.

That relief funding has to be paid via the Senate by law – Pay-As-You-Go, or PAYGO. Legislation can’t result in an increase to the federal budget deficit without an offset from increased revenue in one place or reduced spending in another.

In other words, the federal budget must be neutral.

Because of that, many in the home-based care world feared that providers would be called on to help offset ARPA’s spending. But that will not be the case.

Instead of a 4% cut to all Medicare providers across different settings, the omnibus bill includes a modification of the 2023 Medicare Physician Fee Schedule that will increase those payments by 2.5% in 2023 and 1.25% in 2024.

“We are pleased we avoided a 4% overall reduction in Medicare payments,” said Tom Threlkeld, spokesman for the National Association for Home Care & Hospice, in an email. “That was a major concern for our members. NAHC advocated forcefully for home health patients and providers, and while we didn’t get everything we wanted, we were able to make some important progress on issues that matter greatly to us. Bear in mind that we are nowhere close to done with our advocacy on some of these issues.”

Another win for home health agencies is the provision that the Centers for Medicare & Medicaid Services (CMS) must provide transparency language moving forward around how it arrives at rate cuts.

One of the biggest gripes providers and advocacy organizations had with CMS’ proposed cuts was not just the cuts themselves, but also the lack of transparency as to how CMS got its numbers.

Home health stakeholders may be encouraged that CMS will now have to share data it uses to determine assumptions of providers’ behavior.

“Having this data will allow for the comparison of behavior before and after the change to Patient-Driven Groupings Model (PDGM), and enable providers to give CMS more accurate feedback on points of disagreement,” Mollie Gurian, vice president of home-based and HCBS policy for LeadingAge, said in a statement to Home Health Care News. “Even though this legislation will not impact the rates for CY2023, that Congress listened to our advocacy and took action to address our concerns is a positive.”

The Washington, D.C.-based LeadingAge is a nonprofit advocacy organization.

The spending bill also requires CMS to meet with stakeholders to receive feedback on rate development for 2024 and release the applicable data before that public meeting.

Other notable inclusions in the omnibus bill are the extensions of both the Acute Hospital Care at Home initiative through 2024 and the Money Follows the Person program at $450 million per year through fiscal year 2027.

Many health systems were hesitant to move ahead on hospital-level care at home given what they called a “legislative cliff.” With more clarity moving forward on the Acute Hospital Care at Home waiver, however, those worries will likely be lessened.

The bill also includes a two-year extension for Medicare telehealth provisions put in place during the COVID-19 public health emergency (PHE) and a two-year delay in implementing the Medicare telemental health in-person requirement.

Senate and House leaders expect to pass the bill and send it to President Biden by the end of the week to ensure there are no interruptions to the government’s activities.

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