Legislative Update: July 23, 2019

According to the current calendar, the House of Representatives is scheduled to adjourn at the end of this week and the Senate will be in session into next week before adjourning for the month of August.

As Congress wraps up their work for the summer, issues around prescription drug pricing and surprise medical billing continue to be a focus. 

Last week, the House Energy and Commerce Committee passed the “No Surprises Act (H.R. 3630)”, which aims to limit surprise medical billing. This legislation may now be considered by the full House in September. At the same time, policymakers continue to develop proposals related to reducing the cost of prescription drugs. The Senate Finance Committee has suggested it will unveil legislation in this area in the coming weeks.

At the same time, ElevatingHOME, VNAA and their partners at Leading Age continue to urge lawmakers to take action to address concerns with the Medicare Home Health Patient-Driven Groupings Model (PDGM) system.

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). Unfortunately, the CMS proposed rule would require an 8% Medicare payment reduction as part of the PDGM implementation. 

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.

Before Congress heads out of Washington next week, it would be helpful for ElevatingHOME and VNAA members to reach out to their Members of Congress to urge lawmakers to sign on as a supporter of the PDGM legislation (H.R. 2573/S.433). 

The more lawmakers that agree to cosponsor and support the PDGM legislation, the better chance the legislation will pass in time to fix PDGM before the January implementation. Please find a template letter HERE you can use to urge lawmakers to support H.R.2573 and S. 433.  We appreciate your work in contacting your local lawmaker on this critical issue!