NAHC Comments on Latest Home Health Proposed Rule

WASHINGTON, D.C. (August 31, 2021)—The National Association for Home Care & Hospice submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the latest home health proposed rule 86 Fed. Reg. 35874. The rule proposed changes to the Patient Driven Groupings Model (PDGM) case mix and reimbursement based on 2020 care data.

NAHC commented that 2020 was an unprecedented year for home health agencies (HHAs), which cared for COVID-19 patients, often receiving patients direct from the hospital. NAHC said while hospitals and skilled nursing facilities received payment boosts during COVID-19, HHAs did not.

The association recommended:

• CMS should maintain the structure and design of PDGM for 2022.
• CMS should withdraw its proposal to recalibrate PDGM case mix weights based on 2020 care utilization data. … It is unreasonable to assume that the chaotic year of health care utilization in 2020 is an appropriate foundation for 2022. It is highly unlikely that home health care delivery in 2022 will be anything comparable to care delivery in 2020.
• CMS should replace its suggested methodology for assessing whether behavioral changes of HHAs resulted in PDGM achieved budget neutrality in comparison to the HHPPS HHRG payment model with a methodology that focuses on behavioral changes, not change in average case mix weight. 
• To comply with Medicare law, CMS must apply a PDGM-related budget neutrality adjustment methodology that exclusively is focused on PDGM-triggered behavioral changes. The change assessment methodology proposed by CMS encompasses changes unrelated to HHA behavioral changes under PDGM. 
• CMS should reconsider its decision to apply the new OMB geographic designations for core-based statistical areas (CBSAs) in the annual wage index. Alternatively, CMS should treat all provider types equally in the transition to an updated wage index by extending the 5% ceiling on negative changes in wage index values as it has done for inpatient hospitals. Otherwise, massive payment rate reductions in certain areas of the country will occur, jeopardizing access to home health care services as hospitals protected by the 5% cap will be able to have a more stable financial base, allowing them to recruit staff more successfully from the same pool of professionals that work in HHAs. 
• CMS should establish a process and methodology to modify HHA payment systems and rates during a Public Health Emergency to address new costs triggered by the public health emergency or unpredicted limitations in payment models.

The comments also included recommendations on the notice of admission for home health agencies, the home health value-based payment program, the home health conditions of participation and other issues. 

Multiple state homecare associations signed on in agreement with the comments.

Read the full letter here.