Law to Protect Home Health Payments Introduced in House

WASHINGTON—Representatives Terri Sewell (AL-7) and Adrian Smith (NE-3) have introduced the Preserving Access to Home Health Act of 2023 in the U.S. House of Representatives. If enacted, the bill would safeguard access to essential, home-based, clinically advanced healthcare services by preventing the Centers for Medicare & Medicaid Services (CMS) from implementing cuts as high as $20 billion over the next decade.

The initial version of the bill, S 2137, was introduced in the U.S. Senate on June 22.  

The National Association for Home Care & Hospice (NAHC) and the Partnership for Quality Home Healthcare (PQHH) praised Sewell and Smith for the move. 

“The Medicare home health community strongly supports this legislation and thanks Representatives Sewell and Smith for their leadership on a Medicare issue that truly threatens access to care for the more than 3 million beneficiaries who rely on this care,” said NAHC President William A. Dombi. “The home health community calls on Congress to ensure the stability that patients and providers urgently need. Since Medicare has again proposed deep cuts to home health in 2024, Congress must act to protect the care their constituents prefer and want.”

The bill is designed to address cuts made to home health by CMS during the implementation of Medicare’s Patient-Driven Groupings Model (PDGM) by making the following policy changes:

• Repealing permanent and temporary Medicare payment adjustments. The bill would repeal the requirement that CMS make determinations related to the impact of behavior changes on estimated aggregate expenditures. The legislation would eliminate CMS’s authority to adjust home health payments based on such determinations under PDGM. This change would take effect, and be implemented, as if it were included in the Bipartisan Budget Act of 2018, which included home health provisions that led to PDGM implementation.
• Instructing MedPAC to analyze the Medicare home health program. The bill instructs MedPAC to review and report on aggregate trends under Medicare Advantage, Medicaid, and other payers and consider the impact of all payers on access to care for Medicare home health beneficiaries. To verify MedPAC’s calculations, the Commission would be required to make its calculations public. This provision would also add requirements for Medicare home health cost reports to include data on visit utilization and total payments by program.

“Patients leaving the hospital need of a smooth transition home but are finding it increasingly difficult to find Medicare home health providers, signaling an immediate need for Congress to intervene and block Medicare from making such strident cuts to home health again this year,” said Joanne Cunningham, CEO of PQHH. “Data suggest that Medicare’s continued cuts to home health are restricting patient access to the safest and lowest-cost care setting following a hospital stay.”

Other home health leaders and advocates also chimed in with their support for the act, including Barbara Jacobsmeyer, president and CEO of Enhabit Home Health and Hospice. 

“Congresswoman Sewell has been a true champion for home health issues during her time in Congress, and she understands how home health helps patients and families transition from hospital to home with compassionate, patient-centered care,” she said. “Whether patients are recovering from surgery or managing a chronic illness or recent injury, Medicare home health is an essential part of the care continuum. We are grateful for the support from the Congresswoman and look forward to working with others in Congress to help protect Medicare’s home health benefit.”

Janet Seelhoff, executive director of the Nebraska Association for Home Healthcare and Hospice, said providers “desperately need” the bill “to stop Medicare’s assault on home health.” 

“Home health patients in Nebraska—and across the country—are encountering more and more barriers with access to care when transitioning from hospital to home, which is a daunting and scary process most families have experienced,” she said.  “We’ve seen closures of home health agencies in rural areas of Nebraska, which have created additional hardship on Nebraskans and their families. Without access to home health, patients must remain in the hospital or accept placement in a nursing facility when they prefer to go home.”

According to a new report published by WellSky, hospitals are finding it more and more difficult to place patients leaving the hospital in the home health setting, underscoring the need to ensure that Medicare’s home health benefit is protected and not further eroded by annual payment cuts. (Read more on this report here.) According to WellSky data, timely discharge and transition to home health following hospitalization is at risk:

·       Home health rejection rates increased by 40% since WellSky’s 2022 report

·       HHA referral volume increased by 11% since WellSky’s 2022 report

·       Hospital average length of stay increased by 11% for patients discharged to home health

The American Hospital Association (AHA) has also voiced concern with Medicare’s planned cuts to home health and their impact on patient discharge, stating in a new regulatory advisory: “AHA is concerned about how the net impact of these proposals may affect beneficiary access to care, as well as impede the ability of hospitals to discharge patients in need of HH care in a timely fashion.”