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Legislation has been introduced in the U.S. Senate designed to prevent cuts to the Medicare home health payment rate as proposed by the Centers for Medicare & Medicaid Services (CMS) in their 2023 proposed rule. Introduced on July 25, 2022, the Preserving Access to Home Health Act (S.4605), is sponsored by longtime home care champions Senator Debbie Stabenow (D-MI) and Senator Susan Collins (R-ME). The National Association for Home Care & Hospice (NAHC) expects a companion bill to be introduced in the House of Representatives later this week.
In its proposed rule, CMS called for a 7.69% reduction to the base payment rate in order to meet a budget neutrality requirement as part of the transition to the Patient-Driven Groupings Model (PDGM). In the Balanced Budget Act of 2018, Congress set parameters for the creation of the PDGM with a 30-day payment episode, removal of therapy utilization in payment determinations, and a new case-mix methodology.
In developing the PDGM, CMS was authorized to make adjustments to the base payment rates to account for behavioral assumptions, which NAHC has long advocated against. CMS was also authorized to make additional adjustments to maintain budget neutrality between projections of what would have been spent under the former prospective payment system and what has been spent under PDGM. In last year's rule, CMS indicated that an approximate 6% cut to the payment rate would be necessary to meet budget neutrality, but elected not to institute it due to the ongoing COVID-19 pandemic.
Senators Stabenow and Collins’ legislation would prevent the proposed cut from taking effect, essentially freezing the current payment rate while allowing for annual market basket inflation updates, until 2026. This would provide stability for providers and patients while allowing for further analysis of CMS data on home health spending, as well as refinement of home health payment policy to ensure patient access is not diminished.
This legislation is a top priority for the home health community at large. Leading up to the legislation’s introduction, NAHC has been updating members of Congress about the CMS proposal and its ramifications for providers and patients. With the bill now introduced, industry groups will shift to building support for the measure. HCAF, in partnership with NAHC and other state associations, is launching a major grassroots effort effective immediately to get the entire home health community involved in fighting for the survival of agencies and the continued access to care for the millions of Americans who deserve and depend upon quality care in the home.
Congress will be in recess throughout August, making members of Congress more accessible to constituents. This is an ideal opportunity for home health professionals to engage legislators and their staff at local events, in-person meetings, over the phone, via email, and on social media. By submitting a letter to the local newspaper, advocates can also increase public awareness about this harmful proposal.
HCAF will unveil the online Medicare Payment Rule Advocacy Center in the coming days to provide step-by-step instructions to take action, as well as resources, fact sheets, and more. In the meantime, please get started now by emailing your lawmakers to urge their support of the Preserving Access to Home Health Act!
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