Home Health & Hospice Week

CMS is not following the law’s intent, lawmakers tell Verma.

Four influential lawmakers have home health agencies’ backs when it comes to behavioral assumption cuts in the first year of the Patient-Driven Groupings Model.

The Centers for Medicare & Medicaid Services has indicated it will include such a cut, based on the idea that HHAs will adjust their behavior to accommodate PDGM’s financial incentives, in the rate-setting calculation for PDGM’s 2020 rates.

Earlier this year, lawmakers introduced companion bills in the U.S. House of Representatives and Senate heading off such a cut, which CMS has estimated at 6.42 percent. The bills, H.R. 2573 and S.433, would require CMS to have evidence of behavior changes before making related rate adjustments and would limit annual cuts for such adjustments to 2 percent (see Eli’s HCW, Vol. XXVIII, No. 18).

However, the legislation hasn’t yet passed into law. Now, Sen. Susan Collins (R-Maine), Sen. Debbie Stabenow (D-Michigan), Rep. Vern Buchanan (R-Florida), and Rep. Terri Sewell (D-Alabama) have sent CMS Administrator Seema Verma a letter urging the agency to change its mind about making such cuts in 2020.

“The changes to home health payment required by BBA of 2018 were not intended to create significant cuts in 2020,” says the July 2 letter. “We are concerned that CMS has not taken into account what may happen to Medicare beneficiaries and their access to home health services as a result of this substantial cut.”

The lawmakers urge CMS to “take a cautious approach in its 2020 behavioral assumptions, knowing data-based adjustments can be made in the years that follow,” according to the letter. HHAs already “will be implementing a new payment model,” the legislators also remind CMS.