The National Association for Home Care & Hospice (NAHC) reached an agreement late last week with the Partnership for Quality Home Health Care, Elevating Home/VNAA, and Almost Family on a joint proposal to rescue the home health community from the grave threat of the Centers for Medicare & Medicaid Services’ (CMS) proposed Home Health Groupings Model (HHGM).
It should be noted that all parties are aware that this proposal is not perfect. It was crafted over many hours of debate and involves difficult choices and necessary compromise. In addition, there may not be enough time for Congress to act. Nevertheless, it is in the best interests of the home health community that we try to secure this relief.
The core elements of the proposal, which was presented to the staff from the House of Representatives Ways and Means Subcommittee on the night of Thursday, October, 26, include the following:
- The rule is withdrawn by way of congressional/CMS agreement;
- Home health reforms are implemented, but no earlier than 2020;
- Reforms are developed through stakeholder involvement and the use of a CMS Technical Experts Panel subject to fully transparent public notice and comment opportunities;
- The reforms include shifting to a 30 day payment period from the existing 60 day episodic payment;
- The base 30-day payment rate is set at a $1772 rate;
- The inflation update (MBI) is reduced by 0 .5 MBI in 2021-2023;
- Rural add-on is extended for 5 years;
- The NAHC-devised reform to the F2F and physician documentation is implemented;
- The NAHC bill that permits Non-physician Practitioners to certify Medicare home health services is enacted;
- The current Home Health Value-Based Purchasing Program demonstration is extended to all 50 states, the District of Columbia, and U.S. territories.
Why has NAHC joined with other stakeholders to submit this proposal? Over the past few weeks, NAHC and others concluded that the threat posed by HHGM was so great that it needed to be withdrawn wholesale, particularly in light of the lack of transparency that shrouded the proposed rule and its impact on home health care. A nearly endless series of meetings and other communications with CMS did not result in the withdrawal of the proposal, nor did CMS provide the information that had been sought to better understand its impact. NAHC and others submitted significant formal comments in the rulemaking process challenging the legal validity of the proposal and questioning the merits of the policy.
We have also begun a campaign to garner congressional support in our fight. A bipartisan majority of the Senate and 174 bipartisan members of the House asked CMS, on our behalf, to withdraw the HHGM proposal, but CMS has not heeded that request. Instead, CMS has stayed silent and has provided not even a hint that it will withdraw this dangerous proposal. We are now approaching the deadline for CMS to issue the Final Rule and while it remains possible that CMS will withdraw the HHGM proposal or modify it in some way, NAHC has determined that we cannot count on that.
While the outline we have proposed above includes a number of important positive changes, it also has its financial impact. The proposed rate of $1772 would be a rate cut, but it is significantly less of a cut than what CMS has proposed, which is approximately $1600. Also, the proposal to shift to a 30-day payment unit is an important departure from the 60-day standard in use since the beginning of prospective payment.
The proposal includes a number of specific protections that would prevent CMS from attempting to implement proposals like HHGM again. It would also maintain the use of a 60-day plan of care, certification, and OASIS timetable.
If the matter progresses in Congress, this may change. However, NAHC is willing to compromise only so far. Access to care must be preserved and the whole home health benefit must be protected. The home health community must have a chance to remain financially viable.
If we do not succeed with the congressional effort, NAHC will continue to fight against HHGM, as it is not slated for implementation before 2019. What’s more, we will take our fight to federal court, if necessary. We earnestly hope that CMS will prefer to work with the industry and remain hopeful that CMS will see the light and withdraw the HHGM proposal from the Final Rule. We will have the answer to that in the next few days.
NAHC thanks everyone in the home health community who has joined our fight to stop this grave threat before it inflicts damage upon millions of patients and their providers. We look forward to a favorable conclusion to this Medicare chapter. In the end, we strongly believe that home health care will continue to progress and grow as it is an essential part of health and the solution to many of the problems in care today.