Home Health & Hospice Week

A March 29 webinar about how CMS is calculating the payment rate cuts under the Patient-Directed Groupings Model left many attendees frustrated, and now the industry is preparing an emphatic response.

Reminder: The Centers for Medicare & Medicaid Services held the “Medicare Home Health Prospective Payment System (HH PPS) Calendar Year (CY) 2023 Behavior Change Recap, 60-Day Episode Construction Overview, and Payment Rate Development Webinar” as required by law. Many providers voiced concerns ranging from statistical calculation validity to current and future access problems (see HHHW by AAPC, Vol. XXXII, No. 12).

The webinar drew 1,779 attendees, a CMS represen­tative confirms to AAPC.

“It was very clear from the discussion that, while the statute prohibits home health payments based on the utilization of therapy under PDGM, CMS has done just that,” the National Association for Home Care & Hospice accuses. “The webinar and related release of data did not offer an opportunity for true dialogue and discussion between home health providers and CMS regarding the agency’s approach to implementing PDGM. The home health stakeholder community continues to believe the CMS methodology and approach is flawed, conflicts with the statute, and has resulted in drastic cuts in payment that are now impacting care delivery across the country,” NAHC maintains in a release.

“It is crucial that CMS take into account that the cost of care has significantly increased, and providers are in no position to withstand further rate cuts without additional negative impact on care access beyond what PDGM has wrought,” Joanne Cunningham, CEO of the Partnership for Home Health Quality, says in the release.

“The reality is that CMS has rebased payment rates to account for the reduction of therapy visits that came about solely because of PDGM,” NAHC President William Dombi says in the release. “CMS must withhold any further rate cuts to avoid the flaws of PDGM combining with uncontrolled cost inflation to destroy access to one of the few Medicare benefits that brings savings to the Medicare program,” Dombi stresses.