Current Actions

Support S.2137/H.R.5159 to Save the Medicare Home Health Program

Wed, 20 Nov 2024 05:00:00 GMT

Support S. 2137/H.R. 5159 to Save the Medicare Home Health Program
The home health community is seeking support for legislation to curb dire cuts to Medicare home healthcare services. The Preserving Access to Home Health Act of 2023 (S.2137/H.R. 5159), introduced by Senators Debbie Stabenow (D-MI) and Susan Collins (R-ME) and Representatives Terri Sewell (AL-7) and Adrian Smith (NE-3), would safeguard access to essential home-based, clinically advanced healthcare services for America’s older adults and people living with disabilities by preventing the Centers for Medicare & Medicaid Services (CMS) from implementing devastating cuts. Passage of this legislation is imperative to ensure the continued functioning of the Medicare Home Health Program.

What does the legislation do?

Stops CMS from imposing certain permanent and temporary payment cuts. In 2020, CMS updated the Medicare Home Health payment system. The new system – the Patient-Driven Groupings Model (PDGM) – is supposed to be budget neutral compared to the old system. Congress charged CMS with ensuring budget neutrality, and gave the agency authority to permanently and temporarily change payment rates to account for provider behavioral changes associated with the new system. Despite stakeholder input, the agency’s interpretation of its budget neutrality mandate has unfortunately led to significant reductions in payment, essentially resetting base payment rates at much lower, unsustainable levels, which will deepen in future years. The bill repeals CMS’s authority to make these permanent and temporary payment cuts based on its misguided budget neutrality methodology.
Instructs MedPAC to analyze the Medicare Home Health Program. Under current law, the Medicare Payment Advisory Commission (MedPAC) is allowed to review the effect of Medicare payment policies on the delivery of healthcare services outside of Medicare. This provision would require MedPAC to report on aggregate trends under Medicare Advantage, Medicaid, and other payers, and consider the impact of all payers on access to care for the Medicare population. It also requires MedPAC to be transparent in its calculations, and it updates the Commission’s Medicare home health cost reports to include data on visit utilization and total payments by program.

What Is Important to Know about CMS Cuts to Home Healthcare

The New Home Health Payment System: In 2018, Congress directed CMS to change the Medicare home health payment system beginning in 2020. In doing so, Congress required the new payment system be budget neutral compared to the old system, intending that post-2020 payments should be as if the new system had not been enacted. To achieve budget neutrality, CMS was authorized to make certain payment adjustments on both permanent and temporary basis that allowed for a reconciliation of assumed behavior changes and actual behavior changes.

Cuts to Home Health are Massive: On June 26th CMS released their proposed rule for Calendar Year 2025. Included was a 4.067% cut to the home health base payment rate. This comes on top of a 3.925% cut for 2023 and a 2.89% cut for 2024. These cuts are based on a flawed methodological approach for calculating the impact of provider behavior under PDGM. In addition, CMS proposes an increase in temporary “claw back” cuts to home health payments to approximately $4.5 billion, up from $3.5 billion last year. These cuts make for an impossible environment for home health providers.

See Summary Here: Link to File

Ask Congress to Reject Efforts to Reduce the Hospice Aggregate Cap in an End-of-Year Bill!

Thu, 08 Dec 2022 05:00:00 GMT

In early 2020, the Medicare Payment Advisory Commission (MedPAC) approved a recommendation that Congress enact legislation to wage adjust the hospice aggregate cap (the "cap") and cut it's value across-the-board by 20%. MedPAC provided no analysis supporting the appropriateness of the cap cut except that it would change financial incentives and potentially reduce long lengths of stay on the benefit. MedPAC estimates that the number of hospices that exceed the cap would roughly double as the result of these changes. As Congress is negotiating a year-end omnibus legislative package, there is a threat they may consider cutting the cap to pay for other, non-hospice issues, such as reducing scheduled cuts to physicians or extended telehealth provisions.

Cutting The Cap By 20% Will Make It Harder For Some Of The Most Vulnerable Patients To Get Hospice

While the recommendation is an attempt by MedPAC to address outlier hospice program utilization, this overly blunt proposal is problematic for a number of reasons, including:

Patient access to care could be significantly reduced: a 20% cap cut would create disincentives to serve patients that have a more unpredictable disease trajectory, such as those with dementia and organ failure, thereby disenfranchising entire categories of patients’ access to the hospice benefit.
It could further exacerbate health disparities in hospice access and utilization: The individuals most likely to have their access to hospice impacted by the cap reduction (those with dementia and other neurological diagnoses) are also more likely to be from medically underserved communities that already have lower rates of hospice utilization.
It may result in increased overall spending by Medicare: Any proposal that could limit hospice use, such as the cap reduction, may result in increased overall spending for Medicare, as patients who might have been served by cost-saving hospice instead utilize more expensive and aggressive care such as hospital, ER, and skilled nursing facility services. Recent research has shown that hospice use by Medicare beneficiaries is associated with significantly lower total health care costs across all payers, including Medicare.

A deep cut to the hospice cap is a crude tool to change hospice financial incentives and fails to take into consideration the many factors that contribute to variations in patient care needs. These factors include a more complex patient population for whom establishing an accurate six-month prognosis can be challenging, as well as greater variation in overall patient mix.

Congress must NOT enact major hospice policy changes such as a cap cut in a rushed and unfocused way in the sprint towards a end-of-year omnibus bill, especially as there have been no congressional hearings or public review of the implications of this policy on patient access.
Reject Proposed Cuts to Hospice Aggregate Cap FACT SHEET

Preserve Access to Medicare Rural Home Health Services

Thu, 30 Sep 2021 04:00:00 GMT

Since the inception of the Medicare Home Health Prospective Payment System, the rural add-on has stood as a crucial safeguard ensuring that Medicare beneficiaries in rural areas enjoy access to the full scope of the Home Health benefit. In many parts of the country home care workers must travel great distances – more than an hour in some cases – to deliver care to their patients. In some areas, unique modes of transportation are also required, including floatplanes and boats.

These scenarios place additional financial burdens on home health agencies to meet the cost of travel expenses. Home health agencies are also forced to employ additional professionals to offset the decreased number of hours that a clinician can spend on direct patient care throughout their work day due to increased travel times. These burdens are not faced by agencies providing care in most urban areas.

The Bipartisan Budget Act of 2018 (BBA) provided for the current extension, though on a targeted basis, with complete phase out by 2023. The BBA provides three different rural addon factors as follows:

1. The top 25% of rural counties by utilization of the benefit per 100 eligible beneficiaries – 1.5% add-on in 2019, 0.5% add-on in 2020. 2. Counties that have a population of 6 or fewer individuals per square mile – 4% add-on in 2019 followed by 1% decrease per year thereafter. 3. All other areas – 3% add-on in 2019 followed by 1% decrease per year thereafter.

2.The BBA also called for an analysis to be conducted by the Office of the Inspector General (OIG) “of the home health claims and utilization of home health services by county (or equivalent area) under the Medicare program” to be conducted by 2023.

Congress Should:

Extend the home health rural add-on at 3% to all services provided in rural areas through 2024. This will create stability and protect access to care while the OIG conducts their analysis and allows for more precise policy decisions to be made in future legislation. This extension would provide protection of access to care while the new payment model, PDGM, takes effect.

Medicare Home Health Rural Add On Fact Sheet

Call your Members of Congress Today

Tue, 02 Jun 2020 04:00:00 GMT

OAHC members and individuals that support home care in Oregon should never hesitate to reach out to their elected officials and voice their opinion. If you'd rather advocate by picking up the phone and calling, that's great! Congressional staffers are on hand to take your call, listen to your concerns and record them for the Congressman or Senator. Often, there are so many calls on a particular issue like home care, that these phone calls become a high priority for the Congressman / Senator to address.

So don't hesitate. Pick up the phone and call today! Tell your Congressman that you support home care in Oregon and you want for him or her to make sure that his/her votes on issues do not negatively impact the access to home care services in our state. You'll be glad you made the call!