Home Health & Hospice Week

Members of Congress have introduced a bill in the House that would head off the behavioral adjustment payment reduction in the Patient-Driven Groupings Model. Sen. Susan Collins (R-Maine) introduced a version of the bill in the Senate in February.

The bills, H.R. 2573 and S. 433, would require the Centers for Medicare & Medicaid Services to have evidence of behavior changes before making related rate adjustments. CMS has indicated it will make preemptive behavioral adjustments in the first year of PDGM, with an initial 6.42 percent cut floated.

The new bill would also limit behavioral adjustments to 2 percent per year, and would loosen eligibility requirements for Medicare Advantage and Medicare Shared Savings Program patients. The 2 percent annual limit “would provide stability as providers transition to the PDGM model,” the National Association for Home Care & Hospice says in its member newsletter.

“This legislation is a crucial check on Medicare’s regulatory actions that threaten access to home health,” says NAHC President William Dombi. “CMS’s arbitrary reimbursement cuts in the new 2020 payment model will create barriers to the full scope of the Medicare benefit. CMS should not be able to rely on speculation and assumptions as to how a home health agency might act in establishing a new payment system. It sets a dangerous precedent that only puts care needlessly in jeopardy.”