Key Issues

E-Mail Congress to PROTECT the Home Health Benefit
CMS is Proposing Deeper Cuts to Home Health Payments in 2020
 
Last year, Congress passed the Bipartisan Budget Act (BBA) of 2018 which included various reforms to the Medicare home health benefit. One such provision called for the implementation of the Patient-Driven Groupings Model, a new budget neutral payment model that authorizes the Centers for Medicare & Medicaid Services (CMS) to make changes in reimbursement rates based on assumptions of provider behavior in response to the payment model reforms.
 
CMS has since taken this authority and incorporated behavior based rate-reductions to take effect in 2020 as included in the final CY 2019 Final Rule, and most recently the proposed 2020 Medicare home health rule. Last year, CMS projected that in order to offset potential increased spending under the new payment model providers would see a 6.4 percent payment reduction for an episode of care. CMS has since proposed an 8 percent rate cut for 2020.  These reductions are based on the assumptions that providers will up-code and also add additional visits to Low Utilization Payment Adjustment (LUPA) cases to obtain the full episodic payment. For providers to not lose money, CMS is planning to preemptively reduce home health payments based on how the agency thinks providers will react, which actually incentivizes the type of behavior CMS is concerned providers will engage in. .It is notable that these projections significantly differ from their 2017 assumptions in the proposed, but never finalized Home Health Groupings Model.
 
Both the U.S. House and the Senate have introduced legislation (H.R. 2573/S. 433) that addresses providers' concerns by removing the ability to adjust rates based on assumptions, but rather in response to observed evidence of behavioral changes using actual claims data. By requiring PDGM to utilize actual evidence of behavioral changes, the bill would ensure a smoother transition to the new payment system.  The Senate legislation would also allow Medicare Advantage (MA) plans to waive the "homebound" requirement for home health services when the plan or payment model determines that providing care in the home would improve patient outcomes and reduce spending on patient care.
 
H.R. 2573 has three Texas original cosponsors, Rep. Kenny Marchant (R-TX - 24), Rep. Jodey Arrington (R-TX-19), and Rep. Mac Thornberry (R-TX-13), and thanks to the grassroots efforts of TAHCH  members, the bill now includes several more Texas Delegation Members including Reps. Henry Cuellar (D-TX-28), Lance Gooden (R-TX-5), John Ratcliffe (R-TX-22), Pete Olson (R-TX-22), and Vincente Gonzalez (D-TX-15). If you live in their districts, please contact their office and thank them for their support!
 
Now more than ever, we need your help in urging more Members of the Texas Congressional Delegation to co-sponsor H.R. 2573!  PDGM will begin in less than six months, which leaves a short window of time for Congress to pass this critical legislation.   Please  e-mail your U.S. Representative today and request them to Co-Sponsor H.R. 2573 and e-mail Senators Cornyn and Cruz asking them to Co-Sponsor S. 433.

Information

Texas home care and hospice members may learn more about our positions or take action on a state or federal issue by clicking on the links below.

Federal/National Issues

Support the Palliative Care and Hospice Education and Training Act (HR 647)
In 2010, the American Academy of Hospice and Palliative Medicine estimated an existing need for 6,000 or more full time physician equivalents to serve current needs in hospice and palliative care programs.  However, at maximum capacity, the current system would produce only about 5,300 new hospice and palliative medicine certified physicians over the next 20 years.  This falls far short of the projected growing needs of the rapidly aging population and does not address the growing need for similarly trained non-physician professionals, including palliative nurses.
This legislation would:
  • Amend the Public Health Service Act to increase the number of permanent faculty in palliative care at accredited allopathic and osteopathic medical schools, nursing schools, social work schools, and other programs (including physician assistant education programs).
 
  • Promote education and research in palliative care and hospice and support the development of faculty careers in academic palliative medicine.
Contact your Congressman today to take action and support the Palliative Care and Hospice Education and Training Act (HR 647)
Protect the Medicare Home Health Rural Add-on
The longstanding Medicare rural add-on for home health services will be phased out over the next 2-4 years, threatening the provision of medically necessary home health in rural areas.  This three percent payment modifier to reimbursements for services provided in rural areas continues to be crucial to maintaining access to care.
 
Congress has repeatedly determined, with bipartisan support, that the home health rural add-on is needed to maintain care access and quality in rural areas since the 1980s because:
  • There are higher costs for home care in rural areas primarily due to travel time;
     
  • Home care is often the substitute for primary care in rural areas with the shortage of physicians;
     
  • A loss of access to care in rural areas negatively impacts patients and Medicare as care and its costs shift to institutional care;
Rural home care brings great value to rural residents as it helps prevent the need for urgent care, inpatient hospitalizations, and institutional care.  Home health agencies have demonstrated that the combination of highly skilled staff and modern health care technologies brings high quality of care to rural residents.
 
What can Congress Do?
  • Extend the 3% rural add-on for three years;
     
  • Require a study on its application and any needed reforms to ensure its ongoing success.
Contact your Congressman today to take action and support Medicare Home Health Rural Add-on. 

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