Home Health & Hospice Week

Legislation aims to eliminate adjustments.

Witches and ghosts aren’t the only scary things haunting home health agencies this month. Medicare’s 2019 final payment rule is due at the end of this month or beginning of next, and it may contain a drastic payment reform model that will cut agencies’ pay rates to boot.

It was a victory for the home care industry when the Bipartisan Budget Act of 2018 passed in February required the Centers for Medicare & Medicaid Services to make its payment reform proposal budget neutral. However, BBA 18 also allowed CMS to preemptively make adjustments based on assumptions about the way agencies’ behaviors would change under the new methodology.

The result: Although the Patient Driven Groupings Model is supposed to be budget neutral, it actually reduces the 30-day episode base rate by 6.42 percent under the model proposed to take effect in 2020. CMS assigns a -4.28 percent adjustment for expected changes in HHAs’ clinical group coding, a 1.75 percent reduction for Low Utilization Payment Adjustment changes, and a -0.38 percent adjustment for comorbidity coding changes, says the 2019 proposed rule published in the July 12 Federal Register.

Lawmakers in the U.S. House and Senate have introduced legislation that would eliminate CMS’s authority to make adjustments based on behavioral assumptions preemptively. Instead the bills would require CMS to make changes based on “observed evidence,” meaning “statistically valid data from the most recent cost report and claims regarding changes in the nature of home health agency patients, patterns of care, service costs, and claims coding,” according to S. 3458.

“These bills will provide the means to stabilize access to care while Medicare transforms the payment model in significant ways,” National Association for Home Care & Hospice President William Dombi says in a release.

“With more and more seniors — especially seniors who are frail and suffer from multiple chronic conditions — requiring home healthcare, it is critical that payment reforms are based on actual behaviors, not arbitrary assumptions, so that home healthcare services are not disrupted,” says Keith Myers, chair of lobbying group the Partnership for Quality Home Healthcare and LHC Group CEO, in a release.