Key Issues

Ask the U.S. House of Representatives to Implement Rate Changes Based Data Rather than Assumptions

Just following the Senate bill (S. 3458) that was introduced to protect home health payment, a companion bill (H.R. 6932) was introduced in the U.S. House of Representatives that would eliminate the Centers for Medicare and Medicaid Services’ (CMS) ability to reduce reimbursement rates for home health care.

The Bipartisan Budget Act (BBA) of February 2018 authorized CMS to make rate adjustments on the basis of assumptions of provider behavior in response to payment model changes. CMS responded by proposing a 6.42 percent rate reduction in its annual update in July.

H.R. 6932, sponsored by Reps. Ralph Lee Abraham (R-LA-5), Scott DesJarlais (R-TN-4), Vern Buchanan (R-FL-16), Terri Sewell (D-AL-7), and Garrett Graves (R-LA-6), removes the authorization for CMS to impose rate adjustments that are assumption-based changes, instead requiring that observed evidence of provider behavior change be the method for determining rate adjustments. Additionally, the legislation calls for a phase-in of the adjustment should it exceed two percentage points.

Keith Myers, Chairman of the Partnership for Quality Home Healthcare, also applauded the legislation in a joint statement with NAHC. “The Partnership applauds this group of Senate and House lawmakers for introducing these vital pieces of legislation, which will better align Medicare payment with patient care by ensuring payment adjustments are made based on observed behavioral changes among providers. With more and more seniors – especially seniors who are frail and suffer from multiple chronic conditions – requiring home healthcare, it is critical that payment reforms are based on actual behaviors, not arbitrary assumptions, so that home healthcare services are not disrupted.”

Please urge your U.S. Congressman to support H.R. 6932. 

Ask U.S. Senators to Implement Rate Changes Based Data Rather than Assumptions

As part of payment reforms to the Medicare Home Health benefit, CMS is going well beyond congressional intent and is proposing deep cuts to reimbursement rates based on assumptions about provider behavior.  No data or evidence was used in their assumptions.  This will undoubtedly harm home health patients and providers.
In February, Congress passed the Bipartisan Budget Act (BBA) of 2018.  Included in this law were various reforms to the Medicare Home Health benefit.  One such provision called for budget neutrality in any change to the payment model, so that future spending would remain consistent with projections of current spending levels.  Additionally, Congress authorized CMS to make changes in reimbursement rates based on assumptions of actual provider behavior in response to the payment model reforms.
CMS has since taken this authority and proposed a 6.42% rate reduction in 2020.  These reductions are based on the assumptions that providers will up-code and also add additional visits to LUPA cases to obtain the full episodic payment rather than data of actual provider behavior. 
It is notable in their finalized rule for the Skilled Nursing Facilities, CMS states that they did “not have any basis on which to assume the approximate nature or magnitude of these behavioral responses.” It is vastly inconsistent for assumptions to be made about one provider type, but not another.
Legislation (S. 3458) introduced by Senators Kennedy and Cassidy seeks to remedy these inconsistencies by removing the ability to adjust rates based on assumptions, but rather in response to observed evidence of behavioral changes. Please urge your Senators to support S. 3458.


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.

State Issues

Call or Write your state legislator to SUPPORT EVV Transition Relief NOW!
Implementation of EVV has been challenging and costly to our state, home care providers, and MCOs. Many providers have undergone multiple system integrations and continue to be challenged with data accuracy due to vendor system issues and other factors. This results in data that cannot be accurately validated to allow for the submission of a timely claim for payment and this is not acceptable.
On March 23, 2018, HHSC announced that the contract with MEDsys will not be renewed, expiring on November 6, 2018. This will require over 600 providers to spend hundreds of thousands of dollars delivering thousands of new devices, re-training all of their staff on the new devices and phone numbers, retooling all software interfaces with the new system, retraining back office staff on administration of the new system and increased back end visit maintenance that will result in increased staff time and overtime hours during the course of the transition. 
These costs must be reimbursed.  Contact your legislators today and request the following transitional relief:
  • Cease all recoupments by MCOs for all providers back to April 2016.
  • Provide a streamlined process for all providers to appeal the recoupments related to EVV, administered by HHSC.
  • Suspend compliance plan during transitional period for all providers.  Both the transitioning providers and providers who are already using Data Logic may be impacted by this transition. 
  • Allow transitioning providers to bill for the visits required to install the new Small Alternative Devices.  HHSC already has a billing code and established rate used by home care providers to install home Telemonitoring equipment (99090). 
  • Port the 1-800 number related to the MedSys system so that providers may continue to use their assigned number.  This will decrease some of the training costs for the direct service worker.
  • Allow for the transfer of both client and attendant ID to Data Logic system.  This will decrease the cost of assigning new IDs and the training required to ensure direct service workers utilize the new IDs.
  • Allow visit maintenance to stay open during the transitional period.
Your Representatives and Senators must know how this is impacting your business and the care of your clients.  They are here to help you and take action with HHSC on your behalf.

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