Sens. Blackburn, Collins Submit Letter of Concern to Dr. Oz

WASHINGTON—Sen. Marsha Blackburn and Sen. Susan Collins submitted a letter to Centers for Medicare & Medicaid (CMS) Administrator Dr. Mehmet Oz expressing concern for the future of the Medicare home health benefit, including continued payment cuts leading to further agency closures in their communities.

“We write to express our strong concern that Medicare’s home health agency (HHA) benefit, which gives qualifying seniors the dignity and convenience of receiving skilled care in their homes at far less taxpayer expense than an institutional stay, faces grave circumstances that will dramatically curtail, or cut of entirely, access to this critical cost saving benefit,” the letter said.

The letter goes on to discuss how the Bipartisan Budget Act (BBA) of 2018 called on CMS to create a new payment model for HHAs beginning in January 2020. According to the letter, Congress required the new payment model to be budget neutral, and the Congressional Budget Office (CBO) said the shift in payment models would not result in any change to program spending. However, after the program was implemented, budget neutrality was not actually applied, and the letter states the CBO estimated 2023 expenditures would be $23 billion while the CY Home Health Final Rule states the total aggregated expenditures for home health was approximately $16.3 billion.

“In implementing the new payment model over the 2020-2025 period, CMS did not apply budget neutrality to the new system but instead imposed sweeping across-the-board rate reductions on HHAs that Congress never called for nor intended,” the letter reads. “CMS applied these cuts year-over-year and subsequently led nurses, therapists, home health aides, caregivers and seniors who rely on home health services to face delays in starts of care, fewer in-home visits and diminishments in benefits. Each of these scenarios were made worse by CMS’ own unwillingness to rectify misjudgments about rapidly escalating clinical labor costs, which have increased by 9% since passage of the BBA of 2018.”

The letter ends with the senators’ request that Oz use the full authority under the law and pause any planned payment cuts in the CY 2026 proposed rule for HHAs. Furthermore, they call for the  allowance of clinician experts, seniors and their families and CMS to discuss system improvements that sustain care, improve quality and contain health care cost growth.

The Alliance CEO, Dr. Steve Landers, released a response on behalf of the nonprofit praising the senators and the letter’s message.

“The Alliance is deeply grateful to Senators Blackburn and Collins for their continued leadership and advocacy on behalf of the millions of seniors who depend on Medicare home health services,” Landers said. “Payment reductions are already forcing agency closures and leading to dangerous access barriers and delays in care for beneficiaries across the country. CMS’s reductions to home health reimbursement—the most cost-effective care setting—are pushing our seniors into hospitals and expensive institutional facilities, driving up costs for taxpayers while compromising patient outcomes through increased readmissions and higher mortality rates. Policymakers should focus on addressing fraud and abuse and value-oriented innovation rather than across-the-board cuts. We must act now to focus on preserving and protecting this essential benefit that keeps patients healthy, safe and where they want to be—at home with their families.”