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The Centers for Medicare & Medicaid Services (CMS) is proposing a 6.42 percent rate reduction for home health services in 2020. This reduction is based on the assumption that providers will up-code and add additional visits to Low-Utilization Payment Adjustment (LUPA) cases to obtain the full episodic payment. These projections significantly differ from their 2017 assumptions in the Home Health Groupings Model (HHGM). Further, in their finalized rule for the Skilled Nursing Facilities payment rule, CMS states that they did “not have any basis on which to assume the approximate nature or magnitude of these behavioral responses.” It is wildly inconsistent for assumptions to be made about one provider type, but not another.
Senators John Kennedy (R-LA) and Bill Cassidy (R-LA) have introduced legislation, S.3458, would eliminate the usage of assumptions in rate determinations, and mandate that and adjustments needed to maintain overall budget neutrality in the Medicare home health benefit be based on observable evidence that provider behavior change did occur.
“This legislation, if enacted, would help ensure greater financial stability for Medicare home health providers during the most dramatic payment change they have experienced since the inception of the prospective payment system,” says NAHC President William W. Dombi. “Attempts to predict home health provider response to payment changes in the past proved faulty, and preemptively penalizing providers in the absence of clear evidence guarantees harmful consequences.”
The National Association for Home Care and Hospice (NAHC) fully supports this measure and will be working towards introduction of similar language in the House of Representatives.
It is vital that the home health community speak loudly and with one voice on this matter. By using NAHC’s Legislative Action Center, you can contact your representatives in Congress and ask them to support S. 3458 and protect home health patients and providers today. Congress can protect home health, but we need your voice to make it happen.
About: The National Association for Home Care & Hospice (NAHC) is the voice of home care and hospice. NAHC represents the nation’s 33,000 home care and hospice providers, along with the more than two million nurses, therapists, and aides they employ. These caregivers provide vital services to Americans who are aged, disabled, and ill. Some 12 million patients depend on home care and hospice providers, who depend on NAHC for the best in advocacy, education, and information. NAHC is a nonprofit organization that helps its members maintain the highest standards of care. To learn more about NAHC, visit www.nahc.org.