Home Health & Hospice Week

As the countdown to the 2021 final rule for home health payment ticks down, home health agencies’ comments on the Patient-Driven Groupings Model are getting a boost from a high-profile U.S. Senator.

“I write to request that you revisit the calculation of the ‘behavioral assumption’ rate reduction in the home health payment system and consider eliminating the proposed 4.36 percent reduction for calendar year (CY) 2021,” Sen. Susan Collins (R-Maine) says in an Oct. 1 letter to Centers for Medicare & Medicaid Services Administrator Seema Verma. “I am concerned that continuing this payment rate reduction in 2021 could affect continued access to home health care services.”

Collins continues, “CMS should base these behavioral adjustments on observed evidence, rather than on assumptions of potential provider behavioral changes, and … any necessary rate increases or decreases should be phased in to limit the risk of disruption in care.”

Collins points to a recent study by Dobson DaVanzo & Associates that estimated PDGM payments will be up to 22 percent below budget-neutral payment levels for 2020 (see HCW by AAPC, Vol. XXIX, No. 33). That analysis “indicates that in the first four months of 2020, home health spending was significantly lower than projected, and a subsequent analysis of May and June claims data indicates that these trends have continued,” she tells Verma.

“As we look for ways to ensure that the pandemic does not create devastating long-term health consequences due to delayed care, it is critically important that CMS avoid undue payment cuts that could threaten access to home health care services,” Collins concludes.

“We hope CMS will consider the concerns flagged by Senator Collins — as well as other lawmakers in Congress — and eliminate the 4.36 percent cut in their final payment rule for 2021,” says Joanne Cunningham with industry lobbying group The Partnership for Quality Home Healthcare in a release.

Collins’ letter follows a recent similar one from U.S. Rep. Vern Buchanan (R-Florida) (see HCW by AAPC, Vol. XXIX, No. 37).

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