Home Health & Hospice Week

HHAs have only months to secure legislative change.

The home health industry is fighting to head off Patient-Driven Groupings Model pay rate cuts that will also take effect in January.

In the 2019 final rule, the Centers for Medicare & Medicaid Services hung onto a “behavioral adjustment” pay reduction, estimated at 6.42 percent, for assumed clinical group upcoding, comorbidity diagnosis code upcoding, and Low Utilization Payment Adjustment gaming (see Eli’s HCW, Vol. XXVII, No. 39-40).

That “adjustment” would strip an estimated $1 billion from Medicare home health spending in 2020, says the Partnership for Quality Home Healthcare lobbying group in a release.

Watch for: A bipartisan group of U.S. senators has introduced legislation, S. 433, that would require CMS to implement adjustments after behaviors are observed, not by predicting them in advance. The change “would ensure a smoother transition to the new payment system,” the National Association for Home Care & Hospice praises in its member newsletter.

The bill also calls for “a phase-in of payment changes,” limiting losses or gains to 2 percent per year, while still ensuring budget neutrality is maintained, NAHC adds. And it would allow for waiver of the homebound requirement.

NAHC expects House lawmakers to introduce a companion bill there soon, it says.