Legislation to Stop PDGM Rate Cuts Introduced in The House of Representatives

Posted on Friday, May 10, 2019 1:33 PM

This week, new legislation was introduced in the House of Representatives to stop Patient Driven Groupings Model (PDGM) rate cuts.  The PDGM model created by CMS will subject home health providers to a 6.42 percent cut in the base rate derived from assumptions of how providers might respond to the implementation of the PDGM model.

The Home Health Payment Innovation Act of 2019 (H.R. 2573) would eliminate CMS’ ability to make rate changes on the basis of assumptions, instead requiring actual behavior change to be the standard for reimbursement adjustments. Also, if an adjustment in excess of two percent is necessary, the legislation requires that the amount be phased in by no more than two percent per year. This would provide stability as providers transition to the PDGM model.

“This legislation is a crucial check on Medicare’s regulatory actions that threaten access to home health. CMS’s arbitrary reimbursement cuts in the new 2020 payment model will create barriers to the full scope of the Medicare benefit. CMS should not be able to rely on speculation and assumptions as to how a home health agency might act in establishing a new payment system. It sets a dangerous precedent that only puts care needlessly in jeopardy,” said NAHC President William A. Dombi. “This legislation would provide stability in transitioning to the PDGM model and ensure any reimbursement adjustments are made only in response to actual changes in provider billings. Further, the legislation allows for waivers to the restrictive homebound requirement in certain circumstances, which will benefit Medicare participants. We thank the bill sponsors for their leadership on this issue and for working to protect the Medicare Home Health benefit.”

Source: NAHC Report

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