Home Health Allies in Congress Tell CMS to Ensure PDGM Fairness

Posted Monday, May 16, 2022

Two U.S. Senators and two Representatives have written a bipartisan letter to the Centers for Medicare & Medicaid Services (CMS), urging the government agency to craft a CY2023 home health payment proposed rule that ensures “payments under the Patient Driven Groupings Model (PDGM) are fair to providers and ensure patient access to high-quality care.”

“A key part of the upcoming rule is the evaluation as to whether PDGM was budget neutral in 2020,” wrote Senators Debbie Stabenow (D-MI), Todd Young (R-IN), Reps. Terri Sewell (D-AL) and Vern Buchanan (R-FL). “We are concerned that CMS may not be able to reliably determine whether any change in aggregate payments in 2020 was caused by provider behavior, the impacts of COVID-19, or other aspects of the new payment system. To the extent such a determination is possible, we believe CMS should consider applying pre-PDGM provider behaviors to establish the estimated spending that would have occurred in the absence of PDGM.”

In addition, the members urge CMS to carefully consider data and comments submitted by stakeholders to last year’s rule where CMS offered a proposed methodology for the required budget neutrality calculations. Stakeholders raised concerns that the CMS methodology does not reflect an appropriate comparison resulting in unwarranted projected payment cuts. CMS noted that most commenters disagreed with the methodology and committed to considering alternative approaches to refine it.

With the costs of providing quality services continuing to rise, payment stability is needed to ensure access to vital home health care services. An inaccurate or premature budget neutrality adjustment would only compound the risks brought on by higher service costs. Home health has been on the front lines of the COVID-19 response, reaching patients in need throughout the pandemic. Supporting home health requires fair and appropriate Medicare payment policies.

Source: NAHC Report

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