WASHINGTON, D.C. (May 9, 2019)—On Wednesday, May 8, a bill to prevent the Patient-Driven Groupings Model (PDGM) rate cuts was introduced in the House of Representatives, an important priority for the home health community and something advocates from the National Association of Home Care & Hospice (NAHC) have been working on.
The PDGM model devised by the Centers for Medicare & Medicaid Services (CMS) will subject home health providers to a 6.42% cut in the base rate derived from assumptions of how providers might respond to the implementation of the PDGM model.
Introduced by Representatives Terri Sewell (D-AL-7), Vern Buchanan (R-FL-16), Ralph Abraham (R-LA-5), Ann McLane Kuster (D-NH-2), Kenny Marchant (R-TX-24), Jodey Arrington (R-TX-19), Garret Graves (R-LA-6), John B. Larson (D-CT-1), Mac Thornberry (R-TX-13), Scott DesJarlais (R-TN-4), and Jimmy Panetta (D-CA-20), the Home Health Payment Innovation Act of 2019 (H.R. 2573) would eliminate CMS’s ability to make rate changes on the basis of assumptions, instead requiring actual behavior change to be the standard for reimbursement adjustments. Further, if an adjustment in excess of 2% is deemed necessary, the legislation requires that the amount be phased in by no more than 2% per year. This would provide stability as providers transition to the PDGM model.
The bill would also allow for waivers to the homebound requirement for beneficiaries covered by Medicare Advantage plans or those in a Medicare Shared Savings Program.
The legislation is identical to its companion bill, S. 433, which was introduced by Senator Susan Collins (R-ME). The Senate bill enjoys bipartisan support, with 11 cosponsors currently and more expected to join soon.
“This legislation is a crucial check on Medicare’s regulatory actions that threaten access to home health. CMS’s arbitrary reimbursement cuts in the new 2020 payment model will create barriers to the full scope of the Medicare benefit. CMS should not be able to rely on speculation and assumptions as to how a home health agency might act in establishing a new payment system. It sets a dangerous precedent that only puts care needlessly in jeopardy,” said NAHC President William A. Dombi. “This legislation would provide stability in transitioning to the PDGM model and ensure any reimbursement adjustments are made only in response to actual changes in provider billings. Further, the legislation allows for waivers to the restrictive homebound requirement in certain circumstances, which will benefit Medicare participants. We thank the bill sponsors for their leadership on this issue and for working to protect the Medicare Home Health benefit.”
“I know firsthand the benefits of home health care. When my dad was left wheelchair-bound after a series of strokes, my mom needed help caring for him. He was lucky enough to receive care from highly-skilled and caring nurses and other health care professionals right where he wanted to be—at home,” said Rep. Sewell. “Home health providers were not only a lifeline for my dad, their services are critical for seniors, disabled individuals and those with limited mobility in my district. The Home Health Payment Innovation Act preserves access to existing home health services under the Medicaid program while also providing a pathway to expand use of home health care without increasing Medicare program spending.”
“Home health is a critical part of the equation of how we can best provide care to those who need it, particularly seniors in rural areas,” said Rep. Ralph Abraham, M.D. “This bill will ensure that there are no interruptions in the delivery of home health so that seniors can access the care they prefer. I look forward to working with Congresswoman Sewell and other members of this bipartisan coalition to pass this bill for the good of our seniors.”
Visit nahc.org for more information.