Bill Dombi Archives - Page 2 of 2

BREAKING NEWS – CMS Proposed Rule for 2025

by Kristin Rowan | Jun 27, 2024 | CMS, Regulatory

by Kristin Rowan, Editor

CMS Proposed Rule for 2025

Citing “budget neutrality adjustments”, the Centers for Medicare & Medicaid Services (CMS) June 26 issued its proposed rule for 2025 for the home health prospective payment system. Here are the highlights:

Overall net reduction in home health payments by $280 million dollars
Market basket update of 3.0%
Productivity adjustment of -0.5%
Base payment rate reduction of 4.067% due to PDGM
Update fixed dollar loss for outlier payments
Update LUPA thresholds, functional impairment levels, and comorbidity adjustment subgroups

We did the math. This is an overall reduction in payment by 3.6%. This come after multiple years of similar adjustments that reduced the overall payment rates.

Included in the proposal is an additional adjustment to the fixed-dollar loss amount for high-cost outliers. This will reduce payments another 0.6%.

As we focus primarily on the payment reductions, CMS is looking at additional data. CMS provides a detailed account of the requirements for behavior assumptions and actual changes, as outlined in earlier rules. Using CY 2023 claims, and the methodology from the CY 2023 final rule, CMS believes they paid more under the PDGM system than they would have under the old system, leading to the deduction in base payment rate.

HHA Conditions of Participation

In addition to the payment cuts, CMS is also proposing an update to the Conditions of Participation. This new standard would require HHAs to develop, apply, and maintain a policy for accepting new patients into service.

According to the proposal, CMS is not moving to add or modify any quality measures from the Quality Reporting Program. They do, however, propose to modify some patient assessment items related to health-related social needs. This would require HHAs to collect and report data related to living situation, food, and utilities. This proposed modification would be implemented beginning with the calendar year 2027 QRP.

COVID-19 Reporting

Also included in the CY 2025 proposal is a revision to the infection prevention and control requirements for long-term care facilities. The revision calls for an extension on reporting some of the Covid-19 data elements to the Centers for Disease Control and Prevention. It also requires influenza and RSV reporting beginning January 1, 2025.

Additional Items

CMS also used data from OASIS-D and OASIS-E, making adjustments for missing and altered data from the two different information sets. The proposed rule includes a new methodology to address the issue of varying data sets from OASIS-D to OASIS-E.

LUPA add-ons are meant to establish equitable compensation for all home health services. CMS is proposing an occupational therapy (OT) specific LUPA add-on factor, rather than continuing to use the PT add-on factor for OT.

Payment groups under the PDGM model use an associated case-mix weight and LUPA threshold, specific to each of the 432 payment groups. CMS is proposing a recalibration of the case-mix weights, including funtional levels and comorbidity adjustment subgroups.

Request for Information: CMS is seeking feedback on Future Performance Measure Concepts for the expanded HHVBP Model. New proposed measure include care activities like bathing and dressing, which are not currently included in the function measures. Additional potential measures include family caregiver status and claims-based falls with major injuries.

Feedback

The American Hospital Association has expressed “serious concerns” about the payment rate adjustments in the proposed rule. “We urge the agency to adequately resource HH providers as they are a critical part of the care continuum,” AHA wrote. “We are particularly concerned about the substantial size of the agency’s proposed budget neutrality adjustment, a cut of 5.653%, and again call on CMS to withdraw it.” The AHA has asked CMS to revise its accounting methodology to more accurately account for changes in the payment system and care delivery due to PDGM.

President of the National Association for Home Care and Hospice (NAHC), Bill Dombi, today released a statement:

“The 2025 proposed version of Medicare home health payment rates shows the ongoing and predictable rate reductions impacting home health agencies since the beginning of the new payment model in 2020. That decline is solely due to a fatally flawed budget neutrality methodology that CMS employed to arrive at the rate adjustments,” stated NAHC President William A. Dombi.

“While this means that Medicare spending on home health services will continue to decline as costs continue rise, the more important element is that care access and utilization continues to decline at significant levels. When Congress set Medicare payment reform in motion starting in 2020, it was not planned or even expected that the outcome would be that nearly 500,000 Medicare beneficiaries would be able to access care or that those who could find care would get fewer services,” he added.

“Congress must step in immediately to put an end to this dismantling of the Medicare home health benefit. The value of home health services is not only undeniable; it has been proven by CMS in its analysis and expansion of the highly successful Home Health Value Purchasing demonstration project. We call on Congress to correct what CMS has done and prevent the growing harm to the millions of highly vulnerable home health patients that depend and will depend in the future on this essential Medicare benefit. Fortunately, longstanding advocates for home health care, Senator Debbie Stabenow (D-MI) and Senator Susan Collins (R-ME) have introduced S. 2137 to eliminate the rate cuts. We urge the Congress to support this legislation and enact it into law before the end of the year. The 2025 rate cuts must not take effect” Dombi added.

Comments

CMS has issued a fact sheet with more details on their assumptions and calculations. You can access the fact sheet here. The proposed rule can be downloaded here.

CMS will accept comments on the proposed rule through August 26th.

# # #

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Joint NAHC-NHPCO Statement on Signing of Affiliation Agreement

by Rowan Report | Jun 21, 2024 | Partner News

June 18, 2024

Washington, D.C. and Alexandria, VA – On June 10, the Board Chairs and chief executive officers of the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO) met in Washington, D.C. to formally sign the affiliation agreement between the two leading organizations in the care at home community.

NAHC and NHPCO are the two largest organizations representing and advocating for providers of care in the home and the millions of disabled, elderly, and dying Americans who depend on that care. With more than 90 years of experience between them, NAHC and NHPCO provide world class education to help their members deliver the best possible care and tireless advocacy to expand access to home and community-based services.

“The NAHC-NHPCO Alliance will be the leading authority and unifying voice of the care at home community,” said NAHC Board Chair and Chair-Elect of the Alliance Kenneth Albert. “The leadership of both organizations have worked for 18 months to make this happen and the talented staff at NAHC and NHPCO are already hard at work integrating the two organizations. Together, we will make home the center of health care.”

“This alliance between NHPCO and NAHC will create the most powerful voice the care at home community has ever had,” said NHPCO Board Chair and Vice Chair-Elect of the Alliance Melinda Gruber. “For members, it means access to the best education and expert advice, as well as a strong advocate for sensible policies that help providers deliver the best possible care to the millions of Americans who need it the most.”

“The affiliation of NAHC and NHPCO is a historic event,” said NAHC President and CEO William A. Dombi. “Unifying the voice of health care at home has been a longstanding goal of NAHC, as it is the essence of the original formation of NAHC in 1982. Combining our two organizations will significantly strengthen that voice for the benefit of our members and the patients they serve.”

“The community of providers delivering care primarily in people’s homes is stronger when we work together,” said NHPCO Interim CEO, Ben Marcantonio. “We have demonstrated that strength in recent years with shared advocacy efforts and joint research that have helped change the conversation in Washington and beyond. Aligning NHPCO and NAHC into one new organization will mean we can better serve our members well into the future.”

The signing of the agreement takes NAHC and NHPCO into a new phase of an ongoing process. Beginning July 1, the organizations will begin integrating operations, a process that is expected to take the rest of the year. That process will take place under the name the NAHC-NHPCO Alliance while the future name of the organization is determined. Considerable progress on a new name has been made and is in process of trademarking approvals. Meanwhile, a robust search for a CEO for the new organization is under way, with dozens of qualified candidates being considered.

Press Contacts:

Thomas Threlkeld, NAHC Director of Communications
- tom@nahc.org // 202-547-7424
Elyssa Katz, NHPCO Marketing and Communications Manager
- ekatz@nhpco.org // 571-281-0220

###

About National Association for Home Care & Hospice (NAHC)

The National Association for Home Care & Hospice (NAHC) is the voice of home care and hospice. NAHC represents the nation’s 33,000 home care and hospice providers, along with the more than two million nurses, therapists, and aides they employ. These caregivers provide vital services to Americans who are aged, disabled, and ill. Some 12 million patients depend on home care and hospice providers, who depend on NAHC for the best in advocacy, education, and information. NAHC is a nonprofit organization that helps its members maintain the highest standards of care. To learn more, visit http://www.nahc.org.

About NHPCO

The National Hospice and Palliative Care Organization (NHPCO) is the nation’s largest and oldest membership association for providers who care for people affected by serious and life-limiting illness. Our members deliver and expand access to high-quality, person-centered interdisciplinary care to millions of Americans. NHPCO provides education and resources to support that mission. Together with our advocacy partner, the Hospice Action Network (HAN), we serve as the leading voice advancing public policy to improve serious-illness and end-of-life care, while our CaringInfo program provides free resources to educate and empower patients and caregivers. nhpco.org.

The Future of NAHC: An Interview with Bill Dombi

by Kristin Rowan | May 30, 2024 | Admin, Advocacy, CMS, Regulatory

by Kristin Rowan, Editor

NAHC President Bill Dombi announced at last week’s CAHSAH annual meeting and expo that he would end his tenure at NAHC and retire at the end of 2024. We reached had an interview with Dombi on Thursday, May 23rd. He said he was not prepared to speak yet about his upcoming retirement, but we should hear more about that soon.

In the meantime, he provided additional details from his session at CAHSAH. We also discussed updates on the lawsuit against CMS and the status of the merger between NAHC and NHPCO. Tim’s article from last week talks about Dombi’s progress with Senator Wyland.

Ongoing Litigation

When we last spoke with Bill, he told us about the lawsuits filed against CMS. The suit claims that the budget-neutral calculations were based on faulty data and outdated software. These calculations determined the reimbursement rate reductions. Dombi explained the process for those lawsuits.

“The first round of the battle is around whether the court has the power to hear the case either at all or at that point in time. The courts are littered with litigation that have been dismissed on jurisdictional grounds,” Dombi offered. The court dismissed the lawsuit and the case is now closed. The Department of Justice (DoJ) attacked jurisdiction to get the case dismissed. Most concerning, according to Dombi, was the DoJ’s question of whether the statute passed by Congress precluded any litigation. If the courts had found in their favor, they would have dismissed the lawsuit no further suits could be filed. Luckily, that argument didn’t hold. The second attack was whether NAHC had expedited administrative review, which is the argument that caused the dismissal. Now, they have to establish that it would be futile to get CMS to agree to expedited judicial review.

Next Steps

In light of the dismissal, NAHC had to decide whether to appeal the ruling, exhaust the expedited review step with CMS, or both. Ultimately, they decided not to appeal and is pursing the review with CMS. This process could take up to 6 months, according to Dombi. Although they are pursuing the review, CMS has already stated that their final position is that the budget neutrality has been calculated within the law. Dombi feels the review is futile because CMS is not going to change their position. Now, they just have to prove the futility.

Two-Step Approach

Advocacy from NAHC, NHPCO, and other individuals and organizations was always intended to be a two-pronged effort: Litigation and Congress. The two do not interfere with each other. Even though the court dismissed the litigation suit in favor of judicial review, the approach in Congress continues. Of Senator Wyland, Dombi said, “A year ago at this time, his view was that home health agencies needed no relief. Now, he’s indicated a willingness to find a way to help home health agencies and recognizes that the cuts have been harmful to home health agencies and others that provide care.” According to Dombi, it was the personal stories and individual provider information that was crucial in swaying Wyland. The organizations continue to meet with other members of Congress to persuade them in the same way.

Dombi Provides Merger Update

Last year, NAHC and NHPCO announced they would join forces and merge into a new, as yet to be named, organization. That merger is still moving forward, but there are a lot of odds and ends to tie up. Dombi told us, “Nothing is final, final, but I don’t see anything but tailwinds moving forward.” The two organizations are still hoping for a July 1, 2024 launch of the organization. There is an active, open search for a new CEO to actively run both organizations as one. According to Dombi, no one has been slated for that position yet, so they may end up launching before there is a CEO in place.

The two organizations have already started integrating. They have lobbied together and they have worked on policy together. Additionally, they are integrating the association management system and building a website. “We feel confident enough that it’s going to reach the finish line that we’re investing time and money in these elements,” Dombi said. The two organizations can continue to operate together without a CEO, but there are a lot of decisions that need to be made that won’t be made until after there is a CEO.

After the Merger

Once the merger is complete and the two organizations operate under a new name with a new CEO, Dombi and his counterpart Bill Marcantonio of NHPCO will stay on for some time. Dombi will take the title President Emeritus and Council to the organization and Marcantonio will become the Chief Integration Officer. The new name of the organization has not been announced. Dombi says a lot of things are tied together, from an action standpoint, and it’s better to announce all of those details together along with the new name.

Reflections From Bill Dombi

When asked what was next for him after the merger is completed and he moves to retirement, Dombi reflected on his career:

“I’m proud of what I’ve accomplished in my life, but I’m more proud of what the people I work with I have accomplished. It’s not the first time we’ve tried to merge the two organizations, but this time, we had all the right ingredients and I’m proud of that. I live with the confidence that my constituency is up to the challenge. Every time they get kicked back, they’re right back at it.

To see where we are today compared to the 70s, we are so many light years ahead of where we were then. I mean, we’re talking about a hospital level of care at home. That was part of the dream. The fore-runners of healthcare at home truly believed those things were possible. The problems that caused the workforce shortage are multi-faceted, so the solutions are multi-pronged.”

We will continue following the story of both the lawsuits and the merger and update you as soon as there is more information.

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only.
editor@therowanreport.com

Bill Dombi Spring Tour has two Major Announcements

by Tim Rowan | May 22, 2024 | Admin, CMS, Regulatory

by Tim Rowan, Editor Emeritus

For the last time, NAHC President Bill Dombi is spending another Spring on airplanes. It is state association meeting season, and the Bill Dombi Spring Tour has been bringing his regular Capitol Hill update from coast to coast, this time adding the announcement that he will retire at the end of the year.

After 40 years with NAHC, the lengthy standing ovation Californians gave him at the end of his Tuesday speech was well-deserved.

Advocacy and Change

Bill’s core message has not changed, though the details of his ongoing battle to force CMS to take HHAs and Hospices more seriously has its 2024-2025 nuances. “Letting Congress know that you are an important healthcare sector, and clearly the most popular sector, is not NAHC’s job alone. Every one of you has power. Use it. Make your voices heard.”

Meetings with the Senate Finance Committee

To illustrate the point, he related a story about his recent visit to Portland to meet with the Chair of the Senate Finance Committee, Ron Wyland (D-OR).

“Senator Wyden has been one of the major roadblocks to Medicare agencies getting fair payment rates. I went to see him with a group of agency owners and workers to describe the hardships the current and planned pay rate cuts will impose, and to explain the exact problems with the dumb formula CMS is using to calculate those pay rates.

“The Senator said, ‘But MedPAC says you make too much money and rates should be cut. Were they wrong? Or has something changed?’

Reaching Agreement…Almost

“Both, the group and I harmonized. One by one, each agency representative told him about the growing demand of an aging population, the difficulty hiring staff with the salaries our low pay rates allow them to pay, and a full litany of all the problems with Medicare Advantage.

“By the end of our meeting, we hadn’t turned him 180 degrees, but I could see he was beginning to turn.”Later, Dombi added, he met with Senator Debbie Stabenow (D-MI), who is not only a member of the same Finance Committee but the fourth in line in the Senate pecking order. She offered to have a conversation with her colleague, and that turned Senator Wyden the rest of the way toward changing his position 180 degrees.

You Can Make a Difference

“If you think you as an individual owner have no power in Sacramento, Congress, or the White House,” Dombi concluded, “think again.”

See sidebar for the complete list of Finance Committee members. Everyone has power, but if you are a voter in one of their states, you have an even more powerful voice.

The Bill Dombi Spring Tour will continue throughout the year until his retirement. Join Dombi at the 2024 Financial Management Conference & Expo in Las Vegas, July 21-23 and at the 2024 Home Care and Hospice Conference and Expo in Tampa, October 20-22.

Senator Ron Wyland (D-OR)

SENATE FINANCE COMMITTEE MEMBERS

Chair: Ron Wyland (D-OR)
Ranking Member: Mike Crapo (R-ID)
Debbie Stabenow (D-MI)
Chuck Grassley (R-IA)
Maria Cantwell (D-WA)
John Cornyn (R-TX)
Robert Menendez (D-NJ)
John Thune (R-SD)
Thomas Carper (D-DE)D-
Tim Scott (R-SC)
Benjamin Cardin (D-MD)
Bill Cassidy (R-LA)
Sherrod Brown (D-OH)
James Lankford (R-OK)
Michael Bennet (D-CO)
Steve Daines (R-MT)
Bob Casey (D-PA)
Todd Young (R-IN)
Mark Warner (D-VA)
John Barrasso (R-WY)
Sheldon Whitehouse (D-RI)
Ron Johnson (R-WI)
Maggie Hassan (D-NH)
Thom Tillis (R-NC)
Catherine Cortez Masto (D-NV)
Marsha Blackburn (R-TN)
Elizabeth Warren (D-MA)

# # #

Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com

NAHC Fights for Advocacy on Capitol Hill

by Kristin Rowan | Jan 31, 2024 | Clinical

By Kristin Rowan, Editor

The National Association for Home Care and Hospice joined other advocacy groups this month on Capitol Hill to fight against the looming pay cuts from CMS. Some members of Congress joined the fight for “common sense policies” to expand access to care in the home for Americans.

Rep. Adrian Smith (R-NE-3), who spoke at the event, decried moves against home health, saying “there are cuts looming that are not based on reality” and “we want to make sure reimbursement policies are reflective of the actual realities.” Smith is also the representative who introduce the “Homecare for Seniors Act,” H.R. 1795, which would allow the use of Health Savings Accounts (HSAs) to be used for home care.

Rep. Terri Sewell (D-AL-7) has a personal connection to home care and spoke about how her mother cared for her father through a series of strokes he suffered. She expressed strong opinions about payment reductions that could see home health lose as much as $20 billion dollars over the next ten years. Sewell called the idea “frightening” and said, “I am a big fan of making sure that my constituents have access to quality, affordable health care.”

The Medicare program has admitted that home health is not just a bringing of great care and not just a more cost effective way to provide care, but is a service that provides dynamic value. Care in the home has decreased overall costs by $3.2 billion dollars just in the small segment of value-based payment model test cases. Patients who receive care in the home are re-admitted to the hospital 37% less frequently than those who do not and are 43% less likely to die than patients who do not receive care at home. Still, CMS is looking at additional pay cuts which bring the total payment reduction down 13.72% since 2019. The costs of everything else have increased in that time. According to the U.S. Bureau of Labor and Statistics, the average cost of living has increased 22% since 2019. NAHC President Bill Dombi said, “Where we’re headed in 2024 is that half of all home health agencies will be operating in the red with the cuts facing them in the Medicare program. It’s not a recipe for continued access to care.”

Dombi, along with many others, is predicting that 50 percent of agencies will be operating in the red after the next round of payment reductions and that without a reversal of these pay cuts we could see the end of care at home altogether with a collapse of the home health payment system.

The advocacy event on Capitol Hill helped raise awareness of the plight of care at home among some policymakers, but more help and advocacy is needed. Please, take a few minutes to click the link below and tell your members of Congress to support the Preserving Access to Home Health Act of 2023.

# # #

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Please GO HERE to tell your members of Congress to support the Preserving Access to Home Health Act of 2023

NAHC Fights for Home Health on Capitol Hill

by Kristin Rowan | Jan 31, 2024 | Admin, CMS, Regulatory

By Kristin Rowan, Editor

The National Association for Home Care and Hospice joined other advocacy groups this month on Capitol Hill to fight against the looming pay cuts from CMS. Some members of Congress joined the fight for “common sense policies” to expand access to care in the home for Americans.

Rep. Adrian Smith (R-NE-3), who spoke at the event, decried moves against home health, saying “there are cuts looming that are not based on reality” and “we want to make sure reimbursement policies are reflective of the actual realities.” Smith is also the representative who introduce the “Homecare for Seniors Act,” H.R. 1795, which would allow the use of Health Savings Accounts (HSAs) to be used for home care.

Rep. Terri Sewell (D-AL-7) has a personal connection to home care and spoke about how her mother cared for her father through a series of strokes he suffered. She expressed strong opinions about payment reductions that could see home health lose as much as $20 billion dollars over the next ten years. Sewell called the idea “frightening” and said, “I am a big fan of making sure that my constituents have access to quality, affordable health care.”

The Medicare program has admitted that home health is not just a bringing of great care and not just a more cost effective way to provide care, but is a service that provides dynamic value. Care in the home has decreased overall costs by $3.2 billion dollars just in the small segment of value-based payment model test cases. Patients who receive care in the home are re-admitted to the hospital 37% less frequently than those who do not and are 43% less likely to die than patients who do not receive care at home. Still, CMS is looking at additional pay cuts which bring the total payment reduction down 13.72% since 2019. The costs of everything else have increased in that time. According to the U.S. Bureau of Labor and Statistics, the average cost of living has increased 22% since 2019. NAHC President Bill Dombi said, “Where we’re headed in 2024 is that half of all home health agencies will be operating in the red with the cuts facing them in the Medicare program. It’s not a recipe for continued access to care.”

Dombi, along with many others, is predicting that 50 percent of agencies will be operating in the red after the next round of payment reductions and that without a reversal of these pay cuts we could see the end of care at home altogether with a collapse of the home health payment system.

The advocacy event on Capitol Hill helped raise awareness of the plight of care at home among some policymakers, but more help and advocacy is needed. Please, take a few minutes to click the link below and tell your members of Congress to support the Preserving Access to Home Health Act of 2023.

# # #

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com

Please GO HERE to tell your members of Congress to support the Preserving Access to Home Health Act of 2023

CMS Issues Final Rule for 2024 with Drastic Pay Cut

by Kristin Rowan | Nov 8, 2023 | CMS, Regulatory

By Kristin Rowan, Editor

On November 1, CMS issued its Home Health Final Rule for CY 2024. As expected, the final rule includes drastic pay cuts to Medicare home health services payments. The original proposed rule issued earlier this year included a 5.653% rate reduction, the remainder of the 7.85% reduction from 2020-2021 and an additional 1.636% for 2022, for a total rate reduction of 9.36% overall from the start of PDGM. In a surprising turn, CMS has not implemented the full 5.779% rate cut from the initial proposal, opting instead to introduce the rate cuts over two years. The 2024 rate cut will be 2.890%, half of the full adjustment CMS alleges is still needed. The CMS final rule does not attempt to collect any of the alleged overpayments from 2020-2022, totaling $3,439,284,729.00.

NAHC President Bill Dombi offered this response:

“We continue to strenuously disagree with CMS’s rate setting actions, including the budget neutrality methodology that CMS employed to arrive at the rate adjustments. We recognize that CMS has reduced the proposed 2024 rate cut. However, overall spending on Medicare home health is down, 500,000 fewer patients are receiving care annually since 2018, patient referrals are being rejected more than 50% of the time because providers cannot afford to provide the care needed within the payment rates, and providers have closed their doors or restricted service territory to reduce care costs. If the payment rate was truly excessive, we would not see these actions occurring. The fatally flawed payment methodology that CMS continues to insist on applying is having a direct and permanent effect on access to care. When you add in the impact of shortchanging home health agencies on an accurate cost inflation update of 5.2% over the last two years, the loss of care access is natural and foreseeable.

We now implore Congress to correct what CMS has done and prevent the impending harm to the millions of highly vulnerable home health patients that depend and will depend in the future on this essential Medicare benefit. Fortunately, longstanding advocates for home health care, Senator Debbie Stabenow (D-MI) and Senator Susan Collins (R-ME) have introduced S. 2137 to eliminate the rate cuts. We urge the Congress to support this legislation and enact it into law before the end of the year. The 2024 rate cuts must not take effect.”

The final rule includes the following:

A net 3.0% inflation update
A 2.890% Budget Neutrality permanent adjustment
A $3,489,523,364 alleged overpayment in 2020-2022. CMS has not scheduled a collection of the alleged overpayment in 2024 or any other year yet.
Recalibration of the 432 case mix weights with a separate budget neutrality adjustment in the payment rates of +1.0124%
CMS estimates an increase in CY2024 Medicare spending of $140 million ($525 million inflation increase minus the $455 million rate adjustment plus a $70 million outlier FDL change)

HHAs that fail to provide required quality data will have these rates reduced by two percent.

Non-payment-related changes

In addition to the inflation increase and payment adjustments, the CMS Final Rule includes a number of other changes. These changes include amendments for the payment of Disposable Negative Pressure Wound Therapy, removing and replacing OASIS measures in HHVBP, new coverages and payments in IVIG services, the adoption of two new measures and the removal of one existing measure in HHQRP, coverage for lymphedema therapy items under a new Medicare Part B benefit, and revisions to Medicare provider enrollment requirements.

Hospice Provisions

Hospice Special Focus Program (SFP)

CMS is pushing forward with the Hospice SFP. Despite the commonsense suggested changes requested by NAHC and multiple others, CMS is using a flawed algorithm in the structure and implementation of SFP. This flawed algorithm will fail to identify hospices most appropriate for additional oversight and support. This creates the risk of reducing access to higher quality care and directing patients and families to hospices that perform most poorly relative to health and safety requirements. The official stance from NAHC is strong support of the SFPs goal to improve poor performing hospices, but are emphatically against the method in which SFP is being implemented and will continue to advocate for changes to the structure of the program.

Hospice Informal Dispute Resolution (IDR)

The IDR process for hospice is for condition-level survey findings which may trigger an enforcement action. The finalized IDR process allows hospice programs an opportunity to resolve disputes during recertification or reaccreditation for continued participation in Medicare. this allows for settlement agreement prior to a formal hearing, which will save time and money for the hospice agency. NAHC has additional recommendations for the Hospice IDR process that have not been implemented in the final rule.

Hospice 36-month rule

CMS is extending the “36-month” rule that currently applies to home health agencies and hospices, which is designed to prevent the flipping of Medicare certifications to non-vetted hospice owners. There are several exceptions to the rule for hospices. Even if a hospice undergoes a CIMO, a new owner must enroll as a new hospice and undergo a survey or accreditation unless:

The hospice submitted 2 consecutive years of full cost reports since initial enrollment or the last CIMO, whichever is later.
A hospice’s parent company is undergoing an internal corporate restructuring, such as a merger or consolidation.
The owners of an existing HHA are changing the hospice’s existing business structure (for example, from a corporation to a partnership (general or limited)), and the owners remain the same.
An individual owner of an hospice dies

New hospice owners will immediately be placed into the “high-risk” category for screening requirements and will have to submit fingerprints for a national background check from all owners with a 5% or greater direct or indirect ownership interest.

CMS Final Rule Synopsis and NAHC Response

We reached out to NAHC President Bill Dombi after the release of the Final Rule for CY2024. He provided us with a full breakdown of each provision in the final rule and the NAHC stance on each topic.

You can read all of these changes and how NAHC will continue to advocate for changes to the final rule here.

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Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently started writing for The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

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