Home Health & Hospice Week

Copays also eyed once again.

While most home health agencies cheered when CMS pulled back the Home Health Groupings Model in its 2018 payment rule, one body wasn't happy.

The Medicare Payment Advisory Commission has been urging Congress and the Centers for Medicare & Medicaid Services for years to eliminate therapy utilization from the Home Health Prospective Payment System methodology. And the now-pulled HHGM did that.

Expect MedPAC to once again urge elimination of therapy as a HH PPS factor in its March report to Congress. The Commission will take a final vote on the recommendations for that report in its next meetings Jan. 11 and 12.

The problem: Under current HH PPS, "payments increase as more therapy visits are provided, sometimes increasing by hundreds of dollars for one additional visit," said MedPAC staffer Evan Christman in MedPAC's Dec. 7 meeting discussing its recommendations. "The share of episodes qualifying for these payments has increased every year" under PPS, he added. "This trend, and the fact that more profitable HHAs tend to favor therapy episodes, raise concerns that the financial incentives of the payment system [are] influencing care."

HHGM's fate, and its elimination of therapy in the PPS calculation, is unknown, Christman said. "It is not clear when or if [CMS] will address this vulnerability."

MedPAC commissioners also discussed endorsing a copayment recommendation as they have in the past, but seemed not ready to commit to the idea without more discussion. After all, copays penalize beneficiaries and legitimate providers, not those engaging in fraud and abuse, noted cardiologist Rita Redberg with the University of California at San Francisco Medical Center.