Last week, the wait for the CY 2025 home health final payment rule finally came to end.

On Friday, the U.S. Centers for Medicare & Medicaid Services (CMS) unveiled a rule that included a 0.5% increase to 2025 home health payments, updates to the Conditions of Participation, as well as changes to Low-Utilization Payment Adjustments (LUPAs) and OASIS.

Since then, reactions from home health providers and stakeholders have been pouring in. If providers’ responses could be summed up in one word, it would be “disappointed.” Though the payment reductions were less harsh than what was included in the proposed rule, CMS has now initiated cuts in three consecutive years.

Providers, stakeholders and advocates pushed back on CMS’ payment reductions, and were vocal about the ways in which the rule will likely limit access to care.

To learn more, Home Health Care News rounded up comments from seven industry insiders.

Responses are listed below, lightly edited for length, style and clarity.

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While not surprising, it is disappointing to see CMS continue the pattern of payment reductions for home health care providers, since we have repeatedly raised concerns about ongoing payment reductions during a time of rising operational costs.

We appreciate the move to reduce the immediate impact by cutting the permanent adjustment in half, and credit this to tremendous industry advocacy efforts. Despite this immediate reprieve, the final legislation remains largely unchanged, placing even more pressure on home health care providers as we anticipate rate reductions in future years.

Home health care providers continue to face a stark reality: a future with ongoing margin compression and financial instability that could drive many agencies out of operation altogether. Without sustainable funding adjustments, the home health care sector will struggle to retain a skilled workforce and meet the needs of the growing population that prefers to age in place.

We urge policymakers to recognize the immediate and long-term impacts of this decision on access to equitable, patient-centered care and to collaborate with us in seeking long-term solutions to support the stability and sustainability of essential home health care services.

— Tony D’Alonzo, division director of clinical strategy, innovation and care delivery at Bayada Home Health Care

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While we are appreciative of the final rate adjustment being slightly more positive than the proposed rate, we are disappointed that CMS continues to pursue both temporary and permanent reimbursement reductions for home health providers, which we believe limits patient access to this valuable and much needed service. The impact to our company will not be material given the change to the final rule and the size of our home health business.

The temporary adjustments or “claw back” that CMS has once again deferred for 2025 remains a significant overhang for all home health providers. As an industry we need to advocate against these cuts with Congress, CMS and those advising CMS. The industry also needs to address the inaccuracies and inadequacy of CMS data analysis and calculations that do not support the budget neutral intent of the PDGM law.

— Darby Anderson, executive vice president and chief government relations officer at Addus HomeCare Corp. (Nasdaq: ADUS)

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This outcome is both frustrating and disheartening. Our industry has worked diligently to help CMS recognize the flaws in their analysis and the severe consequences of implementing, for the third year in a row, these drastic cuts to the home health sector. We are at a critical juncture in home health policy making, coinciding with a rapidly increasing demand for in-home skilled health care for Medicare beneficiaries. While we continue our dialogue with CMS, it is clear that Congress needs to take action, more than 60 million Medicare-eligible Americans are counting on it.

— Bud Langham, executive vice president of clinical excellence and strategy at Enhabit Inc.

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While the average annual payment rate cuts for CY 2025 are lower than anticipated, home health care providers will unfortunately still see access-limiting reimbursement levels compared to previous years. This is especially concerning given the urgent need to invest in and nurture a committed clinical workforce in today’s highly competitive post-pandemic landscape.

By CMS’ own account, access to home health care has declined by more than 20% nationally over the last four years. In low-income urban and rural “home health deserts,” where there is already a concerning lack of services, the situation is far worse. In the Bronx, for example, access to home health care was 1/3 less in 2023 compared to 2019, and in some upstate New York communities, access was nearly 40% less. In New York State, more than 180,000 residents lost access to care from 2020 through 2023. It’s time for Congress to act and stop CMS from imposing these misguided cuts.

— Dan Savitt, CEO and president of VNS Health

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We are a value to health care. I think about that Yankee, Dodgers game. I think about sitting with my grandfather watching baseball, and that’s what we’re selling, being in the home. I continue to think it’s looked at through a slightly incorrect lens in a silo. If people just take one step back and see it at the broader level, for the consumer, for the U.S. senior, we are selling the opportunity to be at home and receive your health care in the most affordable setting. I was disappointed, but it was better than what was proposed. Let’s get some real clarity. Give us five or six years to operate with that kind of clarity, and watch what we deliver, because it’s been proven over and over again that we deliver.

— David Jackson, CEO of Choice Health at Home

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The 2025 final version of Medicare home health payment rates continues the ongoing and predictable rate reductions impacting patient access to home health since the beginning of the new payment model in 2020. The decline is due to a fatally flawed budget neutrality methodology that CMS employed to arrive at the rate adjustments, and the risk to homebound patients is compounded by the expansion of Medicare Advantage and associated financial and administrative barriers to care.

We need help from Congress to end this assault on the Medicare home health benefit. Home health has long demonstrated its value as a cost-effective alternative to hospitalization and institutional care and an essential service to over 3 million highly vulnerable Medicare beneficiaries. The hallmark of home health in Congress is the bipartisan and bicameral support that is has had for decades. Legislation is pending that would end these cuts. Longstanding advocates for home health care, Senators Debbie Stabenow (D-MI) and Susan Collins (R-ME) and Congressman Adrian Smith (R-NE) and Congresswoman Terri Sewell have introduced S. 2137 and H.R. 5159 to eliminate the rate cuts. We urge the Congress to enact legislation that will stabilize home health services before the end of the year.

— Steven Landers, CEO of National Alliance for Care at Home

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Though the final payment rule released today is a net aggregate payment increase of 0.5%, or $85 million, this number must be put into context. Although CMS has spread out the baseline cuts, the rule nonetheless finalizes a -1.975% permanent projected adjustment. This brings us to a nearly 9% permanent cut to home health payment since 2023. At the same time, a $4.5 billion temporary adjustment looms.

This combined reduction in payment will harm older adults and families in need of care and the providers who are doing their best to deliver it. Our nonprofit, mission-driven agency members are at risk. We are already seeing provider closures. This is simply unsustainable.

While we recognize CMS provided warning of potential future cuts to home health agencies in previous years’ rule making, the reality is that many providers are navigating a challenging economic environment, including a highly competitive labor market. As a result, even with the agency’s warning, many providers have no further ability to tighten their belts. Future payment reductions and clawbacks are a certainty under the agency’s interpretations of its current statutory obligations. Simply put, without a change in course by Congress and by CMS, access to care will continue to decline. LeadingAge will continue to advocate for a strong home health benefit and for relief for our members.

— Katie Smith Sloan, president and CEO at LeadingAge

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Home health leaders with the Partnership for Quality Home Healthcare (the Partnership) were again disappointed that CMS continued its policy of cuts by finalizing a -1.975% permanent cut to home health in its CY 2025 Home Health Prospective Payment System (HH PPS) final rule. The cut – the latest in a series of troubling rate reductions – comes despite mounting evidence and clear data that patient access to lifesaving care is declining due to consecutive years of cuts to patient-preferred home health. While the final HH PPS rule did mitigate the permanent payment cut proposed by CMS earlier this year, the Partnership warns that any additional cut to home health in 2025 will further restrict beneficiary access.

The cut that CMS finalized nearly negates the market basket increase that is meant to help providers keep pace with rising costs. The outcome of today’s final rule means continued challenges for home health providers as they struggle to keep pace with rising workforce costs. Credible third-party data and evidence we shared with CMS indicate that patient access to home health care is declining. Unfortunately, yet another year of cuts will further destabilize home-based care for older Americans.

Today’s final rule doesn’t change the fact that Congress must intervene to fix this broken payment system that produces year after year of cuts. We are counting on Congress to bring stability to this benefit and preserve access to this lifesaving care.

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