Current Actions

Please tell CMS to pull the 80/20 provision from the Medicaid Access Rule

Fri, 26 Apr 2024 04:00:00 GMT

In the Medicaid Access Rule CMS finalized a requirement that no less than 80% of all Medicaid payments, including but not limited to base payments and supplemental payments, be spent on compensation to direct care workers, for homemaker services, home health aide services, and personal care services. This requirement applies to services delivered under sections 1915(c), (i), (j), (k), and potentially also 1115 of the Social Security Act as well as those delivered through managed care contracts. Notably, it would not apply to 1905(a) State plan personal care and home health services.

The rule defines “compensation” narrowly as:

Salary and wages;
Benefits (such as health and dental benefits, paid leave, and tuition reimbursement);
The employer share of payroll taxes for direct care workers; and
Other remuneration as defined by the Fair Labor Standards Act

Importantly, the rule’s definition neglects to include other crucial costs necessary to provide services.

There are significant negative outcomes that would occur if the 80-20 provision is finalized, including:

This provision will reduce, not increase, access. Individuals who rely on HCBS to live their lives in home-based settings will lose services, particularly if providers cannot meet these new requirements or are forced to restrict innovative, value-added care supports.
The provision appears to have been arbitrarily created and not based on data or an explained rationale.
The restrictive threshold definitions will serve to limit resources for caregiver support and other enhanced care-focused operations, resulting in reduced quality, health and safety, and oversight in HCBS.
The blanket approach undermines state autonomy, creates stark inequities across and within states, limits the ability to modify program requirements, and penalizes providers and states that have more regulation and oversight.
The provision seeks to establish precedent that CMS/HHS has the authority to dictate how state Medicaid dollars are spent by private entities.
CMS imposes this mandate with no existing or planned infrastructure for collecting and reporting out accurate information, financing to support added resource needs, or data to ensure that the dollars are being distributed as intended.

Stop Medicare Cuts to Home Health Care

Tue, 16 Apr 2024 04:00:00 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: This November, CMS finalized a flawed methodological approach for calculating the impact of provider behavior under PDGM, which resulted in a permanent -9.48% cut to Medicare home health payments. Based on the same methodology, CMS plans to implement at least $3.5 billion in temporary “claw back” cuts to home health payments. In total, the permanent and temporary cuts are now estimated to reduce home health payments by more than $20 billion over the next ten years. CMS’ recalculations result in more devastating and deeper cuts to home health each year, making for an impossible environment for home health providers.

Medicaid Personal Care

Wed, 21 Feb 2024 05:00:00 GMT

The House and Senate have prepared their state budgets. There are differences in those proposals. The Senate version has NO increases for Medicaid personal care, while the House version provides funding consistent with minimum wage increases found in House Bill 1. Owners and administrators of Medicaid personal care agencies agree that reimbursement rates are so low that it is impossible to pay aides competitive wages. It is time for this NEW General Assembly to address this long standing reimbursement flaw.