The Last-Ditch Efforts Home Health Providers, Advocates Are Making To Nix Payment Cuts

Any day now, the Centers for Medicare & Medicaid Services (CMS) will release the 2024 home health final payment rule.

In anticipation, home health providers and advocates have been appealing to Congress, educating, calling to action on social media and more.

All of these efforts are the final push from an industry that has been very vocal about its opposition to the proposed rule, which was released in June.


Home Health Care News recently caught up with many of those providers and advocates to learn more about what they’ve been doing to push for a more favorable final rule.

At this point we are focused on a combination of the White House and Congress, pushing for a pause of the proposed rate cut in 2024. Congressional allies are working on our behalf in that respect. We are also hedging our bets by setting up for a congressional effort to stop the cut during the budget process. We need all hands on deck, particularly with home health agency staff contacting their local congressional delegation.

— William A. Dombi, president of the National Association for Home Care & Hospice



With the final rule quickly approaching, Bayada Home Health Care has been all hands on deck, diligently mobilizing our employees and advocates to make sure congressional members hear our voices. In conjunction with PQHH and NAHC’s industry-wide efforts, advocates have called and emailed federal lawmakers and published op-eds to urge lawmakers to support the Preserving Access to Home Health Act. Additionally, Hearts for Home Care – Bayada’s 501 (c)4 advocacy arm – has been active online and in-person, posting on social media and traveling to Washington, D.C., to further enforce our message that congressional action is needed to stop CMS’ proposed Medicare cuts. From our positive conversations with members, we are hopeful that our efforts have been recognized and have helped to move the needle forward on behalf of the entire home health care community.

— David J. Totaro, chief government affairs officer at Bayada Home Health Care


Last year’s home health payment reduction forced many providers to make difficult decisions, from reducing service area to letting go of staff, in order to keep their organizations afloat. Should this year’s proposed 2.2% cut to home health payment be finalized, providers will need to brace for the same impact in 2024. We urge CMS to postpone cuts for this year while we continue work on avenues for permanent relief.

For instance, we see opportunities in ensuring that the Home Health Value-Based Purchasing (HHVBP) Model focuses on the right measures of care. We have also seen an interest from Congress in holding Medicare Advantage plans accountable, which is increasingly important both for providers and the system as a whole as more home health episodes occur in Medicare Advantage. Plans must cover the true cost of service.

We’re already working with members of Congress to begin rethinking how the home health benefit should work. We know it’s on their minds too, as evidenced by the Senate Finance Committee hearing last month and the introduction of the Preserving Access to Home Health Act of 2023, which we support. There’s incredible support for these services, but CMS says its hands are tied on the payment methodology. Change is needed to best support beneficiaries who need these services the most, specifically those in rural and underserved areas. We believe that developing payments to support providers serving these communities will be invaluable. We are also looking into how to better track actual access to home health services. MedPAC’s current definition of access is failing millions of Americans. It’s time to rethink what true access means in terms of choice, in terms of services, and in terms of location.

— Mollie Gurian, vice president of home-based and HCBS policy at LeadingAge


In anticipation of the final rule, the Partnership and our members are using every tool in our toolbox to influence the outcome of the HHPPS for 2024. We are meeting with – and reaching out to – administration officials at the White House, HHS, CMS, and OMB. We are coordinating with our champions in Congress to put pressure on the Biden Administration. We have broadly activated our grassroots army to ask Congress to use its muscle in stopping the proposed cuts. We’re working with NAHC this week to beef up the conversation on social media among our advocates and working with our state association partners to elevate the issue on the local level. It’s critical that all home health stakeholders use their voice right now to speak out about how these cuts will harm patient care.

Once the rule is finalized, the Partnership will be evaluating its impact on access to care for the Medicare population and how it impacts ensuring that providers can meet the high demand for home health services which has been diminishing under the weight of the cuts. I encourage all of us to carefully analyze the final rule to determine whether CMS has taken any action to eliminate or significantly mitigate the deep cuts that have been proposed. Home health has already been cut by billions since 2020 and the market basket has been woefully inadequate to cover the costs of inflation. We, and the entire provider community of caregivers, are ready to intensify our efforts to seek a permanent legislative solution to stabilize home health and protect access to care for the most vulnerable of the Medicare population. The future of the home health program depends on these efforts.

— Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare


We are engaged in a multi-faceted approach to minimize an unfavorable home health final payment rule. We are leveraging our extensive network and resources to layer advocacy action from grassroots to grasstops, engaging not only our 1,000 employees, but also leading on education and technology tools for the industry. By equipping providers with the necessary knowledge and tools, we are helping them prepare for every outcome.

In addition, Axxess is committed to the industry’s viability and the accessibility of home-based care for everyone. We are leveraging our political action committee, the Axxess PAC, to support the united voice and work of our national associations, ensuring that our advocacy efforts are amplified and impactful.

For providers preparing for the possibility of an unfavorable final rule, we recommend staying informed and engaged. By joining forces with industry associations and leveraging resources like the Axxess PAC, providers can collectively work toward influencing positive change and protecting the interests of the home health community.

— Deborah Hoyt, senior vice president of public policy at Axxess


Between now and the issuance of the final rule, Enhabit Home Health & Hospice (NYSE: EHAB) is focused on bringing as much attention as possible to what we know is true: patient access to home health care is being impacted by Medicare’s continued cuts.

In August, our public comment letter and those of many others highlighted to CMS what the impact will mean for patients and providers; then in September, home health experts testified to Congress about the same; and here in October, we are working to focus the attention of the Biden Administration on what will happen if CMS moves forward with its proposal to further cut the Medicare home health benefit. Our elected officials need to be aware of the impacts of the CMS proposal given the priorities around health equity, increasing access to high-quality care and avoiding cuts to Medicare. And importantly, administration officials should know that CMS has the discretion under existing authority to move away from the agency’s proposal.

On top of these efforts, there are also many incredible people from all over the country – many of whom work in home health and understand the importance of this moment – that are taking the time to call Capitol Hill, write a letter to a member of Congress, or even author an op-ed in a local paper, all in a community-wide effort to let our government know that these proposed cuts should not be finalized.

In terms of preparation for the final rule, our local leaders remain focused on managing their resources to continue to deliver our high quality of care in the most efficient manner.

Andrew Baird, vice president of government affairs & policy counsel at Enhabit Inc.


Home health is the foundation of home-based care. The long-standing benefit has opened the door to broader thinking about what’s possible at home. Innovation like hospital-at-home, SNF at home, or home-based services like home dialysis or home infusion would not be possible without the underpinning home health provides.

As we look to a future where seniors are aging in place and higher acuity services are offered at home, we cannot allow this foundation to erode. While the reimbursement structures differ, new care models rely on the precedent and groundwork set by the home health benefit. As providers look toward the possibility of an unfavorable rule, it’s important to share data, patient stories and paint the picture of the detrimental effects of further cuts to this valuable benefit.

— Krista Drobac, founder of Moving Health Home

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