Home health agencies protest 2023 proposed payment rate cuts
One organization has engaged legal counsel, saying it hopes deficiencies identified will be corrected in the final rule.
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Home health agencies have written to the Centers for Medicare and Medicaid Services protesting the proposed 4.2% payment rate cut in the 2023 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Requirements Proposed Rule.
The Partnership for Quality Home Healthcare and LeadingAge decry CMS's proposed permanent 7.69% payment cut to Medicare home health services beginning in 2023, as well as clawback cuts totaling $2 billion beginning in 2024 for services already provided during the first two years of the pandemic.
The proposed cuts equate to a $1.33 billion cut from home healthcare in 2023 alone, with the total cuts reaching up to $18.15 billion over the next 10 years, the Partnership said.
LeadingAge told CMS that "if finalized as proposed, reducing Medicare home health payments by an aggregate 4.2% including a 7.69% negative adjustment to the base payment, coupled with an effort to recoup an additional $2 billion from home health providers, will have a devastating effect on older adults who rely on these services."
WHY THIS MATTERS
The Partnership has advised CMS of legal concerns in the proposed rule and said it hoped the legal deficiencies identified would be corrected in the final rule.
It said it has engaged outside counsel from the King & Spalding law firm to assess the nature and extent of any legal vulnerabilities within the proposed rule that may violate distinct statutory commands from Congress and other areas where it may be vulnerable to challenges under administrative law.
The Partnership's letter calls out increased labor and care delivery costs, technical concerns with CMS' payment methodology, CMS' lack of transparency in data and information and ongoing COVID-19 pandemic impacts. It includes a 2022 labor study from Dobson|DaVanzo & Associates that cites an insufficient supply of clinicians and staff turnover as well as unexpected wage increases and inflation.
LeadingAge is asking CMS to delay the permanent payment reductions for at least one year and not to implement any temporary retrospective adjustments based on behavior. CMS should not use behavioral assumptions to inform temporary retrospective adjustments until a methodology is developed to target the adjustment at providers who are truly outliers on the behavioral changes, the organization said.
Congress has introduced the Preserving Access to Home Health Act of 2022, which would delay the 7.69% percent payment cut proposed for 2023 and block the additional clawback cuts that are set to begin as soon as 2024, according to the Partnership.
THE LARGER TREND
In the proposed rule, released in June, CMS estimated that Medicare payments to home health agencies in 2023 would decrease in the aggregate by -4.2%, or -$810 million compared to 2022.
This decrease reflects the effects of the proposed 2.9% home health payment update percentage (a $560 million increase), an estimated 6.9% decrease that reflects the effects of the proposed prospective, permanent behavioral assumption adjustment of -7.69% (a $1.33 billion decrease) and an estimated 0.2% decrease that reflects the effects of a proposed update to the fixed-dollar loss ratio used in determining outlier payments (a $40 million decrease).
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org
