ST. LOUIS (October 25, 2022)—As the National Association for Home Care & Hospice’s (NAHC) Annual Convention and Expo concluded today in St. Louis, Missouri, one issue loomed over the attendees: What will happen with the federal government's home health final payment rule, which must be released no later than Nov. 2? 

“We have people checking the Federal Register every day at 4:15 Eastern,” said NAHC President Bill Dombi in his address to the conference, which was attended by almost 3,000 people in the home health, personal care and hospice  industry.

“You have a range of action,” Dombi told HomeCare, “from where the rule doesn’t change, and you have the 7.69% cut and whatever inflation adjustments … The other extreme is where [CMS] begs forgiveness for the big mistake they made.” 

Find a summary of the proposed rule here.

NAHC holds the position that home health providers have been chronically underpaid; however, CMS applied the payment adjustment in the proposed rule because it believes providers have been overpaid due to behavioral changes under the Patient Driven Groupings Model.

Dombi said he expects to see some cuts, but providers could also see a higher inflation adjustment, which would result in a flat payment rate. CMS has also floated the idea of phasing in the payment cut, Dombi said, but the association and industry rejected that proposal, citing that even phased in cuts would harm patient care.

“Do you want to die now or die next year?” he said. 

A NAHC study of the industry found that 44% to 51% of home health business would operate in the red in 2023 if the cuts go through as proposed.

On the positive side, Dombi said that advocacy surrounding the rule is the most intense he’s seen in his lifetime. Industry allies in Congress have stepped up, as well, he said. 

"In four months, NAHC members have sent 60,000 emails, tweets, phone calls, etc.," Summer Napier, NAHC director of grassroots advocacy, said in a separate address. "This is more than double the next highest action alert. We've also gained 16,000 additional advocates" from across the spectrum of care—including patients and family members of NAHC members.

"We don't know what the final rule will hold," Napier added. "But, we want you to know your efforts have not been in vain."

The Next 40 Years
NAHC is celebrating its 40th anniversary this year. Dombi noted that in 1982, at the association's founding, less than 1 million people in the United States were receiving service under the Medicare home health benefit; today, more than 7 million people receive care each year. 

In 1982, the Medicaid home- and community-based service (HCBS) benefit existed, but few states had opted into the optional program. President Ronald Regan expanded the benefit and every president since has been on board to further expand the benefit, though Dombi noted it took until 2022 for a president to address the issue in the State of the Union address. 

“We expect, going forward, that whatever the party affiliation might be, that support will continue,” Dombi said. 

As Dombi looked forward, he said it would be ideal if every aspect of care in the home came under the purview of NAHC. 

“It’s not a business thing, but it makes sense,” he said. “Physicians delivering care at home, nurses are delivering care at home. Why should there be a dividing line between the two of those? …What we're seeing happening is the breadth of care expand. I would like to see NAHC as the voice that's unifying those particular interests.”

Dombi added that he wants NAHC to take the lead on initiatives around technology and innovation in the space. He also said that there may be new payment models that help solve some of the reimbursement issues the space is experiencing.

Ultimately, Dombi believes the desire for care in the home will only grow, and NAHC will continue to be the leading voice in that growth.