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Members of Congress Ask CMS to Stop Home Health Cuts Based on Behavioral Assumptions

Posted on Monday, July 8, 2019 12:10 PM

A bipartisan group of U.S. Senators and members of the House of Representatives have written to CMS Administrator Seema Verma to ask her to avoid “reductions in payment due to assumptions, without real-world evidence, about how home health agencies may change billing under the new payment model” debuting on January 1, 2020.

Last year, when Congress passed the Bipartisan Budget Act (BBA) of 2018, it Included various reforms to the Medicare Home Health benefit. One of the provisions called for budget neutrality in any change to the payment model.  Additionally, Congress authorized CMS to make changes in reimbursement rates based on assumptions of provider behavior in response to the payment model reforms.

CMS is incorporating behavior-based rate-reductions to take effect in 2020 as included in the final Medicare home health rule. These reductions are based on the assumptions that providers will up-code and add additional visits to LUPA cases to obtain the full episodic payment.

“During this year’s home health rulemaking cycle, we urge CMS to revisit those assumptions, which would result in a 6.42 percent cut to home health payments for 2020, based on the agency’s internal analysis and modeling,” write the members of Congress. “The changes to home health payment required by BBA of 2018 were not intended to create significant cuts in 2020. CMS has wide discretion in making assumptions, but we are concerned that CMS has not considered what may happen to Medicare beneficiaries and their access to home health services as a result of this substantial cut. In the absence of observed experience and data, CMS should take a cautious approach in its 2020 behavioral assumptions, knowing data-based adjustments can be made in the years that follow.”               

Source: NAHC Report

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