Members of Congress ask CMS to Eliminate Behavioral Rate Cut in PDGM

Posted on Monday, October 19, 2020

Senator Collins (R-ME) and Representative Buchanan (R-FL) have sent independent letters to Administrator Seema Verma asking CMS to drop the behavioral rate cut in the Patient Driven Grouping Model (PDGM).

In PDGM CMS included a 4.36 percent cut to the base payment rate for 30-day episodes. This amount was based on three assumptions made by CMS of how home health providers would behave in response to the implementation of the new model. They deemed the assumptions necessary to ensure a budget neutral transition to PDGM.

“In her letter to CMS, Senator Collins expressed concern the rate cut could result in reduced access to care for Medicare beneficiaries. Her concerns extended to CMS’s plan to continue with the 4.36 percent cut as included in the 2021 rule making process despite an acknowledgement that data is currently limited of how providers have reacted to PDGM since its implementation in January. Specifically she cites the following statement from the proposed rule, “it would be premature to release any information related to these issues based on the amount of data currently available and in light of the current public health emergency.”

Source: NAHC Report

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