Home Health Payment Innovation Act of 2019
H.R. 2573/S. 433 has two key components. First, the legislation would modify the new Medicare Patient-Driven Groupings Model (PDGM) by requiring that the new payment system be implemented in a “budget neutral manner.” Specifically, the legislation would prohibit the Secretary from modifying Medicare home health payment rates based on assumptions of inappropriate case mix changes that could occur under the new PDGM system. Instead, the legislation would require the Secretary to implement payment modifications based only on actual experience and data generated after PDGM is implemented in 2020. In addition, the legislation would limit payment increases or decreases to no more than 2.0 percent per year, with any greater modification being phased in over a number of years.
Second, the legislation would waive homebound rules for services provided to individuals enrolled in Medicare shared savings programs, such as accountable care organizations (ACOs), as well as for beneficiaries enrolled in the Medicare Advantage program. Under the proposal, homebound rules would continue to apply for services provided to Medicare fee-for-service enrollees.