NAHC Submits Comments to CMS on the Proposed Medicare Home Health Rule
August 27, 2013 11:00 AM
The National Association for Home Care & Hospice (NAHC) recently submitted comments to CMS Administrator Marilyn Tavenner on the proposed rule change to Medicare home health services. The comments outline NAHC’s objection to the rebasing rule changes as well as several other issues that could greatly affect the home health community.
The submitted comments state that:
“The 2014 proposed rule includes the most significant change in payment rates since the inception of the Home Health Prospective Payment System in October 2000. With the combination of the rate rebasing and the modifications proposed in the case mix adjustment model, payment rates would decrease by over 14 points over 2014-2017 with the 4-year phase-in of rebasing. Our analysis demonstrates that over 70% of existing home health agencies (HHAs) will be paid less than the cost of care with this NPRM. This proposal will have natural and foreseeable effect of eliminating access to care in much of the country. The NPRM is inconsistent with the rate rebasing authority delegated by Congress to CMS, counter to the publicly available data set out in Medicare cost reports, and a vast regulatory overreach if the goal is to reset payment rates while maintaining access to essential services.
NAHC has had a long history of constructive evaluation of CMS proposed rule changes. Our comments set out below are intended in that spirit. However, we are gravely concerned with this NPRM and the serious adverse consequences that will arise if CMS does not change the proposal significantly. In no way do we believe that CMS intends the vast loss of access to care that we forecast will result from the NPRM. Nevertheless, it is vital that CMS look to alternative methods of rebasing payment rates to ensure continued care access…
The proposed rebasing methodology guarantees that reimbursement for home health services will be less than the average “cost” of care even under CMS’s definition of “cost.” That will occur because the CMS methodology segments elements of home health services in rebasing the payment rates for a bundled 60 episode of care. The formula used by CMS offers payment at the average “cost” of a normal episode combined with less than cost of LUPA episodes along with intentional financial losses on outlier episodes.”
The comments proceed to highlight NAHC’s concerns – backed with significant data – and suggestions for a more equitable rebasing structure. “These comments allowed NAHC to share with CMS some of the most glaring problems with their proposed rebasing rule as it is currently written,” said Bill Dombi, NAHC’s Vice President for Law. "CMS could fairly calculate rebased rates in other ways that would lessen the negative impact access to care. Alternative and valid methods of calculating the average cost of care would reduce the rate cut in half. We also believe that CMS must consider all business costs and the need for capital. If CMS did so, the rate cuts would be further reduced. We intend to carry this message to Congress, seeking its assistance in convincing CMS to change course."
NAHC strongly encourages all providers to contact their congressional delegation requesting that they sign on to the support letters circulating in the House and Senate. All the tools to do so are in the NAHC LAN.
To read NAHC’s full, submitted comments on CMS’ rebasing rule, please click here.