Home Health & Hospice Week

The home health industry isn’t giving up its fight to make Patient-Driven Groupings Model payment rates more fair.

And it has enrolled U.S. Rep. Vern Buchanan (R-FL) as an ally, notes lobbying group The Partnership for Quality Home Healthcare. Buchanan recently sent Centers for Medicare & Medicaid Services Administrator Seema Verma a letter about 2021 rates, asking for CMS to lay off the controversial 4.36 percent payment reduction due to expected behavioral changes.

“There is compelling new data, based upon 2020 Medicare claims data, that indicates in the first four months of 2020 home health spending was significantly lower than projected,” Buchanan says in the Sept. 25 letter. “With these current trends continuing, Medicare home health spending will be well short of the required budget-neutral level, as outlined by Congress.”

A recent study by Dobson DaVanzo & Associates estimated PDGM payments will be up to 22 percent below budget-neutral payment levels for 2020 (see HCW by AAPC, Vol. XXIX, No. 33).

“I am concerned CMS’s CY 2021 proposed HH PPS rule would … carry forward assumptions made well before any of us could have anticipated what 2020 would look like,” Buchanan says. “These rate reductions should be eliminated, because there is compelling data that refutes the need for this reduction.”

Time will tell: CMS is expected to release the 2021 final rule in late October or early November.