The Preserving Access to Home Health Act of 2023 was introduced Thursday. Its largest objective is to prevent further cuts to home health payments in 2024 and beyond.
The bill, if passed, would also strip the Centers for Medicare & Medicaid Services (CMS) of some of its payment-rate setting power and force the The Medicare Payment Advisory Commission (MedPAC) to consider Medicare Advantage (MA) payment rates in its reports.
Sens. Debbie Stabenow (D-MI) and Susan Collins (R-ME) – two long-time champions of home-based care – introduced the bill. A similarly structured bill was introduced in the Senate last July, and introduced in the house three days later.
“Its focus is to restrict CMS’ authority to make permanent and temporary adjustments, which was very similar to the focus last year,” Partnership for Quality Home Healthcare (PQHH) CEO Joanne Cunningham told Home Health Care News. “If passed, the rates would not be subject to the permanent or temporary adjustments [we’ve seen]. … It would restrict CMS’ ability to continue to make reductions to the payment rate.”
Home health providers saw just a 0.7% payment increase in 2023 amid historically high inflation. CMS is seeking a -7.85% adjustment to home health payments, and implemented the first half of that – a -3.925% adjustment – in 2023.
Providers and stakeholders are expecting the second half of that cut to be in the CY2024 home health payment rate proposal, which is set to come out in late June or early July. The Preserving Access to Home Health Act of 2023 is one the measures they’re taking to keep those further cuts from becoming set in stone.
“We strongly support this essential legislation as current policy positions of CMS put access to home health services for the over three million beneficiaries that utilize this care in jeopardy,” National Association for Home Care & Hospice President William A. Dombi said in a statement shared with HHCN. “The Medicare home health benefit has shrunk over the last decade due to various payment cuts, which the most recent of those is the subject of the legislation. We call on both houses of Congress to join Senator Stabenow and Senator Collins in their valiant effort to preserve the home health benefit.”
The home health industry has fought hard against the CMS methodology that is leading to proposed and implemented rate cuts. Up until now, its efforts have largely hit dead ends.
There’s the gripes with the methodology and calculations of CMS. But there’s also an overarching, philosophical problem with CMS’ rate cuts from the home health industry perspective. And that has to do with the fact that home health care is one of the only subsectors that can actually help decrease overall Medicare spend.
Home health care saves the Medicare Trust Fund $1.38 billion – over 6 years – due to avoided hospitalizations and skilled nursing placement, according to NAHC. Plus, with worsening home health access, patients are having to stay in hospitals longer.
“CMS’ own data demonstrates that home health care services provide savings to the Medicare program by shortening a patient’s time spent in the hospital, reducing unplanned hospitalizations and emergency department visits that can lead to inpatient admissions,” AccentCare CEO Steve Rodgers said in a statement shared with HHCN. “While home health care is a small part of the overall Medicare spend, its ability to impact the overall value for Medicare beneficiaries is well documented.”
Dallas-based AccentCare is one of the largest providers of home health services in the country. Its 30,000 workers deliver care across 30 states and the District of Columbia.
The next step will be to secure an introduction of the bill into the House in the coming weeks, according to Cunningham.
“We are also certainly going to be asking members of Congress to support and co-sponsor this legislation,” she said. “All of the folks back in the districts, in the states, who work every single day delivering care to patients. They’re well aware of the challenges ahead and they will certainly join the grassroots army that will be communicating strong support for this to Congress, too.”
CMS and MedPAC’s roles
CMS sets the rates. They therefore bear the responsibility for home health rates being slashed.
“The bill would repeal the requirement that CMS make determinations related to the impact of behavior changes on estimated aggregate expenditures and would eliminate CMS’ authority to adjust home health payments based on such determinations under PDGM,” according to NAHC.
If the bill were enacted, that change would take effect and be “implemented as if it was included in the Biparisan Budget Act of 2018.”
But MedPAC, which regularly suggests home health payments should be reduced, has drawn an increasing amount of ire from home health providers of late.
“When [MedPAC] puts out their reports, they could say, … ‘This only represents this percentage of home health care that is delivered,’ just so people have some sense on the full margin picture,” Michael Johnson, the head of home health and hospice at Bayada, told HHCN in March. “Something so it makes clear to the reader, particularly on Capitol Hill, that there’s another part of the story you have to dig into. That’s what worries me, that that part is not in there.”
That’s exactly what the bill is suggesting MedPAC do moving forward to paint a more holistic picture of the state of home health care.
“The bill instructs MedPAC to review and report on aggregate trends under Medicare Advantage, Medicaid, and other payers, and consider the impact of all payers on access to care for Medicare home health beneficiaries,” according to NAHC.