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Legislation has been introduced in the U.S. Congress that is designed to prevent cuts to the Medicare home health payment rate as proposed by the Centers for Medicare & Medicaid Services (CMS) in the 2023 proposed rule. The Preserving Access to Home Health Act (S.4605/H.R.8581) is a top priority for the home health community at large.
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 the industry 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.
The Preserving Access to Home Health Act would essentially freeze 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.
With the legislation now introduced, industry groups are working to build support for the measure. HCAF's grassroots effort seeks to get the entire home health community involved in fighting for the survival of home health agencies and the continued access to care for the millions of Americans who deserve and depend upon quality care in the home.
Congress is 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. Click here to visit the Medicare Payment Rule Advocacy Center for talking points, resources, and steps to take action now
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