Legislation Introduced to Improve Home Health Behavioral-Based Payments

WASHINGTON, D.C. (February 12, 2019)—Home health leaders with the Partnership for Quality Home Healthcare (Partnership) and National Association for Home Care & Hospice (NAHC) applaud the introduction of S. 433, legislation to improve home health payment reforms to ensure beneficiary access to quality care services is not compromised for America’s growing senior population. Introduced by Senators Susan Collins (R-Maine), John Kennedy (R-Louisiana), Bill Cassidy (R-Louisiana), Rand Paul (R-Kentucky), Debbie Stabenow (D-Michigan), Doug Jones (D-Alabama) and Jeanne Shaheen (D-New Hampshire), the legislation will refine home health payment to ensure behavioral-based payment adjustments are rooted in evidence and observed data.

“We commend Senators Collins, Stabenow and their bipartisan colleagues in the Senate for introducing this Medicare legislation to protect consistent and seamless access to home health services. Refining the PDGM approach is critically important to home health care for America’s growing senior population,” said Keith Myers, chairman of the Partnership for Quality Home Healthcare. “We strongly support this legislation, which ensures CMS uses actual data and observed evidence when making payment adjustments to properly align payment with patient characteristics and quality.”

“The transition to the new PDGM payment model promises to be disruptive for home health agencies that have operated under the current model since 2000. It is not prudent to magnify that disruptive impact by reducing payment rates based on pure assumptions on how agencies will react. The legislation will provide protection from such disruption and ensure continued access to care for nearly 3.5 million Medicare beneficiaries who rely on home health services every year,” said Bill Dombi, president of the National Association for Home Care & Hospice.

Finalized by the Centers for Medicare & Medicaid Services (CMS) last year, the Patient-Driven Groupings Model (PDGM) is the most significant payment change to the home health system in 20 years. If implemented as designed, PDGM will make payment adjustments based on behavioral assumptions as opposed to observed evidence or actual provider billing behaviors. The new payment structure could result in a 6.42 percent payment reduction in 2020—equaling an estimated $1 billion. Home health leaders warn that without the elimination of the behavioral assumption cut, PDGM could lead to instability to all providers, threaten access to care and harm the Medicare home health program for seniors.

S. 433 instead would require Medicare to implement adjustments to reimbursement rates only after behavioral changes by home health agencies (HHAs) that affect Medicare spending actually occur instead of assuming changes might happen. By requiring the payment model to utilize observed evidence of behavioral changes, the bill would ensure a smoother transition to the new payment system. The bill also provides a phase-in of payment changes, limiting losses or gains to 2 percent per year, while still ensuring budget neutrality is maintained. The bill also includes important provisions that allow for the homebound requirement that limits Medicare beneficiaries’ eligibility to receive home health care services to be waived in certain instances.

“We will be working with lawmakers in the House and Senate to advance this important patient-centered legislation so vulnerable beneficiaries do not experience any unintended consequences as a result of Medicare’s payment new model,” added Myers.

Visit pqhh.org and nahc.org for more information.

Find the text of the bill here.