Senate bill 433 and HR 2573 has been introduced in the US Congress. This important legislation will refine payments in the new home health payment system to ensure behavioral-based payment adjustments are based on evidence and observed data, not on assumptions of provider behavior. This legislation is also supported by the National Association of Home Care and Hospice and the Partnership for Quality Home Healthcare.
The new Patient Driven Groupings Model (PDGM) that will go into effect on January 1, 2020, is a major change in the payment system for Medicare home health services. One concerning aspect of PDGM is that the Centers for Medicare and Medicaid Services (CMS) will make home health payment adjustments based on behavioral assumptions as opposed to evidence or actual provider billing data. Basing payment adjustments on assumptions of provider behavior instead of actual data is arbitrary, could create instability for home health services during this time of reform, and could potentially limit patient access.
What S. 433 and H.R. 2573 Includes
S. 433 and H.R. 2573 addresses this concern by requiring CMS to implement adjustments to home health reimbursement rates only after behavioral changes by home health agencies (HHAs) that affect Medicare spending actually occur. The bill also provides a phase-in of payment changes, limiting losses (or gains) to 2% per year to limit the risk of disruptions in care and ensure budget neutrality by 2029. The bill also includes important provisions that limit Medicare beneficiaries’ eligibility to receive home health services to be waived in certain instances (known as the “homebound” requirement).