Posted December 2, 2022
Following the finalization of the home health rule NAHC engaged with the sponsoring offices of the Preserving Access to Home Health Act (S. 4605/H.R. 8581) on refining the legislation to better its chances for passage before the end of the year, as well as strengthen transparency of the Centers for Medicare & Medicaid Services (CMS) in their rate-setting. Our champions on Capitol Hill are working to substitute this amended language in the negotiations for the year-end package. This amendment will not be introduced as new legislation.
While there won’t be a new bill to call for congressional action on, you can still advocate for this revised approach.
Please contact your Senators and Representatives requesting they support a year-long delay (2023) of the home health rate cut and call for added transparency in CMS rate-setting practices. The NAHC Legislative Action Center is set up and ready with this message.
If you are writing your own message or will be speaking with your elected officials here are helpful talking points.
The Centers for Medicare and Medicaid Services (CMS) issued a Final Rule on October 31, 2022, that reduces Medicare payments for home health services by $635 million in 2023 and triggers an estimated $18 billion in payment reductions over the next decade. Congressional action in 2018 required CMS to establish a new payment model that was “budget neutral,” not one that cuts support for home health services by $18 billion.
The impact of those payment cuts would exacerbate the ongoing dismantling of this essential benefit that serves over 3 million of the most vulnerable Medicare beneficiaries, providing them with exceptional quality care in their own homes, preventing high-cost hospitalizations, and offering an alternative to life-changing institutional care while saving Medicare billions in spending every year.
Over the past decade, Medicare beneficiaries have experienced significant reductions in access to home health care that were not authorized or sanctioned by Congress.
- In the last 10 years, Medicare beneficiaries using home health services has dropped from 3.5 million beneficiaries annually to 3.1 million beneficiaries as a result of continually reduced payment rates.
- With the $635 million payment cut in 2023, the permanent rate reduction of 7.85% finalized by CMS, and over $2 billion in planned “clawback” cuts, future care access can only worsen further in the face of $18 billion in current and future payment cuts.
- CMS has portrayed the recent action as an increase in Medicare spending on home health services, but that is highly misleading. The 2022 30-day national standardized payment rate is $2,031.64, yet CMS finalized the 2023 30-day national standardized payment rate at $2,010.69. This represents a reduction in year-over-year payment for care provided by home health agencies beginning in January, despite the significantly increased costs home health agencies continue to experience.
- CMS has refused to provide the data and information necessary to replicate its calculations and fully assess the validity of its methodology.
Bipartisan legislation, the Preserving Access to Home Health Act of 2022, S. 4605, would suspend the behavioral adjustment rate cut to give Congress time to address the complex issues presented by the new payment model. A developing revision of this proposal would focus on suspending the payment cut for just 2023.
What Must be Done
- Support stability in the home health care community in 2023 by suspending the entirety of the behavioral adjustment cut to the CY 2023 home health payment rate in CMS’s CY 2023 Final Rule.
- Strengthened disclosure, accountability, and transparency of the payment rate-setting method employed by CMS, including direct stakeholder engagement, to ensure a budget-neutral transition to the new payment system
Click here to contact your government officials.
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