NAHC Letter to CMS – Withdraw the Home Health Group Model
September 12, 2017 03:36 PM
The National Association for Home Care & Hospice (NAHC) and the Partnership for Quality Home Healthcare have written a letter to CMS Administrator Seema Verma, encouraging her to withdraw the proposed CY 2019 Home Health Groupings Model (HHGM) because the rule is likely to cause considerable disruption and possible loss of care for many home health patients.
The home health industry requires additional information in order to fully assess the impact of the proposed rule, with more complete data analysis, and scrutiny as to the legal and policy authority to make the rule, write authors William Dombi, President of NAHC, and Keith Myers, Chairman of the Partnership for Quality Home Healthcare.
CMS needs to convene a broader workgroup of stakeholders and, in consultation with these stakeholders, evaluate criteria that ensure that all the Medicare benefit is available to those who are eligible, and devote attention to educating all parties who order and provide the valued Medicare home health benefit. The sheer number of changes to the HH PPS incorporated in the proposed version of HHGM make current analyses of its impact difficult to adequately perform and would cause any unintended consequences of its potential implementation near impossible to isolate and address. We welcome the opportunity to engage with CMS on ways to craft rules that are “less complex” and “reduce burdens”, as stated in the Request for Information (“RFI”) contained in the proposed rule.
Specifically, Dombi and Myers ask for additional information on the following issues so that home health stakeholders can fully understand the impact of the proposals in the rule:
How will revenues be addressed that are associated with the 30-day episode periods that receive payment under the current HH PPS but would not be paid under the HHGM? The proposed rule states that the change to 30-day episodes means that home health agencies will be better compensated. The HH PPS law requires both budget neutrality and standardized payment.
The proposed rule states that Table 55 contains “assumptions on behavioral responses.” Do these behavioral responses assume that revenue shortfalls under HHGM will be made up by providers? If so, how? Is there a justification for the “assumptions on behavioral responses”?
It is unclear what the projected total system value would be under CY 2017, CY 2018 (under current law), and CY2019 with the HHGM changes. The proposed rule states that the total system value would be reduced by $950 million in 2019 if the final rule is fully non-budget neutral, or $480 million if the rule is partially non-budget neutral, with the total reduction still being $950 million when fully implemented. This type of an analysis is exactly the type of analysis that the RFI is concerned with because it is bureaucratic and complex, and requires additional clarification in order for its plain meaning to be understood by providers.
The HHGM data set was based on 2013 claims data1 and does not account for the full 14 percent reduction implemented through the Affordable Care Act. Has an analysis been conducted on the impact HHGM would have on access to services going forward? In the CY 2014 Home Health Prospective Payment System Update Rule, CMS estimated that “approximately 40 percent of providers will have negative margins in CY 2017.” We are concerned that the cuts proposed by CMS would be unsustainable for many providers, particularly those in rural areas that are already struggling to provide beneficiaries with continued access to a benefit they depend on.
Additionally, Dombi and Myers are also concerned that:
CMS does not have the authority to change the model of care as outlined in the statute and to do so in a non-budget neutral manner, and
Changing the standard episode of care from a 60-day to a 30-day episode is inconsistent with the statute.
What’s more, CMS continues to make assumptions that do not accurately estimate the financial impact of reductions in the home health payment. For example, when the original home health prospective payment was enacted, it was estimated to save $16.7 billion; however, it ended up reducing overall payments closer to $70 billion. More analysis in this area must be done and cannot be appropriately accomplished within the timeframe for the proposed rule.
Implementing a totally new payment system that significantly cuts Medicare home health, with virtually no input from the industry, puts both vulnerable home health beneficiaries and quality providers at significant risk.
“Medicare’s home healthcare benefit has long made clinically—and cost—effective services available to homebound seniors and disabled Americans,” write the authors. “These services allow senior citizens and individuals with disabilities to receive physician-ordered medical and rehabilitative treatment where they most prefer to remain: in the safety and dignity of their own homes.
NAHC urges CMS to withdraw the HHGM policyand instead work with stakeholders to develop a fully budget-neutral policy that does not limit access to beneficiaries or diminish provider resources.
This issue is NAHC’s top priority and will remain so until the policy is improved. Please stay tuned for further analysis and news about NAHC advocacy on behalf of our members and the millions of aged and disabled Americans they serve.
However, to defeat this payment rule before it brings havoc to the industry, we need home health leaders, employees and patients to make their voices heard by policymakers in Washington, D.C. Without your support and advocacy, this rule cannot be stopped. Please go to the NAHC Legislative Action Center and ask Congress to tell CMS to withdraw the payment rule.