Legislative Update: July 16, 2019
On July 11th, CMS released the Calendar Year 2020 (CY20) proposed Medicare rule on changes to Home Health Prospective Payment System (Home Health PPS).
The CMS proposed rule requires the new Medicare Home Health Payment-Driven Groupings Model (PDGM) to be implemented effective January 1, 2020. The PDGM system was created in the Balanced Budget Act of 2018 (“BBA of 2018", P.L. 115-123).
The BBA of 2018 required that the PDGM system be implemented in a budget neutral manner, meaning that it should not result in inappropriate Medicare payment reductions for home health providers.
Unfortunately, the CMS proposed rule would require an 8% Medicare payment reduction as part of the PDGM implementation. CMS suggests this payment reduction is needed to offset expected changes in coding or other home health agency behavior as the PDGM system is implemented. Last year, CMS made a similar “behavioral assumption” in the CY19 proposed rule.
In response, lawmakers introduced the “Home Health Payment Innovation Act (H.R. 2573, S. 433)”. This legislation would protect access to home health care by ensuring any PDGM payment changes are made based only on actual experience and data. The legislation would specifically prohibit any payment reductions until 2025 and cap any payment reduction at no more than 2% per year.
In the coming weeks, it remains critical for ElevatingHOME and VNAA members to reach out to their Members of Congress to urge their support of the PDGM legislation (H.R. 2573/S.433). Please find a template letter HERE you can use for this Congressional outreach.
In addition to understanding the payment impact of the CY20 proposed rule, we are working closely with our partners at Leading Age to also assess other aspects of the CMS proposed rule.
These proposals include new rules that allow health paraprofessionals to perform at their highest level of training, a proposal to eliminate RAP payments, and the ongoing phase-out of the rural add-on payments, among other items.
As we complete a full review of the proposal, we will continue to share our members’ concerns and comments with CMS to partner together and ensure high-quality home health services are delivered to the growing numbers of Medicare beneficiaries.