Congress: Support bipartisan solutions to protect Medicare home health

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As members of Congress return to Washington following their August recess, we might be tempted to assume the nation is in for more of the same: partisan disagreements, frustrating distractions, and slow progress on critically important policy issues.

Assumptions, however, don’t always pan out. And blindly depending on them can be dangerous.

That’s the message thousands of our nation’s home health providers hope members of Congress will grasp as they get back on Capitol Hill this week. Assumptions – either relating to the behavior of lawmakers or when it comes to policy – don’t serve anyone well.

While we know assumptions don’t always translate to facts, Medicare is basing an entirely new payment model for the home health benefit on just that. The new payment policy – called the Patient Driven Groupings Model (PDGM) – is anticipated to cut home health reimbursements by more than $1.2 billion in the year 2020 alone based on assumptions on how providers may bill for services. At a time when more Americans than ever before are turning 65 – and are in need of quality, cost-effective, patient-preferred, home-based care – destabilizing the sector with such a massive change puts patient care in the cross-hairs.

Today’s problem stems from the Balanced Budget Act of 2018 (BBA), which required the Centers for Medicare & Medicaid Services (CMS) to develop a new budget neutral payment model for the Medicare home health program.

In devising that model, however, the BBA also mandated that Medicare apply “behavioral adjustments” to account for changes in provider behavior unrelated to changes in patients served or services delivered that increase payments. In layman’s terms, CMS is instituting a base rate cut in 2020 of 8.01 percent that would start before any actual provider behavioral changes occur. It’s a billion-dollar problem that seniors and their health care providers will feel acutely next year, if not remedied by Congress.

To most of us, it’s fairly obvious that it’s a tremendously bad idea for Medicare to make assumptions or guesses about provider behavior without any data or evidence. The agency, itself, said so when it rejected payment assumptions for Skilled Nursing Facilities and hospitals in years past. Simply, CMS assumes that home health providers systemically will change their coding to maximize payment in a new model. But there’s no evidence to support this assumption. And risking seniors’ access and the availability of an essential Medicare benefit isn’t the way to find out.

Fortunately, there are lawmakers in Congress who understand the danger of these assumptions. Earlier this year, bipartisan legislation – the Home Health Payment Innovation Act (S. 433 & H.R. 2573) – was introduced in both chambers to require CMS to use actual data – “observed evidence” – before making behavioral assumptions in the payment system. This important legislation also reinforces the need for a new model to be budget neutral and limit a home health agency’s losses or gains to 2 percent per year to ensure stability in the sector.

Home health leaders from 15 states are on Capitol Hill this week urging lawmakers to support this bill to ensure consistent and uninterrupted access to home health for Medicare patients as the sector adjusts to this new payment structure. Since introduction, support for this legislation has steadily grown in both the House and the Senate and on both sides of the aisle.

I’m hopeful that lawmakers will come together to see that the Home Health Payment Innovation Act is passed into law this year for the health and safety of American seniors – and a Medicare benefit that 3.5 million patients readily depend upon.

Tim Rogers is chair of the Council of State Home Care & Hospice Associations & President & CEO of the Association for Home & Hospice Care of North Carolina & the South Carolina Home Care & Hospice Association. 


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