APTA Advocacy Network Newsletter — March 2024 Edition 

Advocacy Marches On 

Spring is in the air. Clocks have sprung forward an hour, March Madness brackets are on the mind, and in Washington, D.C., the cherry blossom peak bloom speculation has begun. 

On Capitol Hill, it has been an intense start to spring as policymakers on both sides of the aisle worked to formulate and pass a bipartisan agreement to keep the government funded and address the Medicare payment cut that went into effect Jan. 1, impacting dozens of providers, including physical therapists. In February, we saw 32 senators come together in a bipartisan effort via a letter to congressional leadership urging more funding for the 2024 fee schedule and saying that such a fix must be included in any spending deal. APTA also advocates made their voices heard in record numbers, demanding that Congress include a fix to the Medicare fee schedule in the spending package deal, and they were successful. 

On March 7, Congress passed a funding package that prevents a government shutdown and provides over $730 million in additional funding (a 1.68% increase to the fee schedule’s conversion factor that impacts payments to all providers) for the 2024 Medicare fee schedule to mitigate cuts. The additional funding provided by Congress will reduce, but not totally eliminate, the entire 3.37% facing a wide range of providers.

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NAHC/HHFMA Medicare Advantage Survey - Your Input Matters!

NAHC | By Bill Dombi

NAHC is embarking on a landmark survey focused on the operational and financial aspects of the relationship between home health agencies (HHAs) and Medicare Advantage (MA) plans.

The survey ties into early MA studies from NAHC that examined the relationships between 2014 and 2020. As such, the 2024 edition provides a crucial opportunity to compare today’s environment with those earlier benchmarks.

In 2024, MA enrollment is at its all-time high, exceeding 50% of Medicare enrollees nationwide, with some localities well in excess of 70%. The impact of MA on HHAs continues to grow each year. The data we seek in this survey is essential to our advocacy efforts on behalf of HHAs and helpful to HHAs in their own business decisions.

Previous NAHC analyses uncovered a significant need for HHAs to subsidize the payment rates of many MA plans to cover the cost of care provided to MA enrollees while also demonstrating higher administrative costs than Traditional Medicare.

We must get significant and widespread participation in the survey to have valid and reliable data. We also encourage you to complete the survey as soon as possible. The data is needed for the current advocacy efforts around MA reform and traditional Medicare PDGM payment rates. You should be able to respond to most of the survey questions with readily available information or estimates.

The same survey in 2020 was completed in an average of 16 minutes.

Thank you in advance for your participation. Once the surveys are collected, we will provide a webinar to review the data outcomes. An in-depth review will also be part of the forthcoming Financial Management Conference in July.

Thank you,

Bill Dombi
President, National Association for Home Care & Hospice (NAHC)

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MedPAC Again Pushes for Home Health Payment Cuts, Highlights Higher Employment Levels

Home Health Care News | By Robert Holly

Staffing shortages remain a challenge in home health care. While that’s true, the overall employment pool in home health care is actually larger now than it was before the COVID-19 pandemic.
 
That’s according to the Medicare Payment Advisory Commission (MedPAC), which issued its March 2024 report to Congress on Friday. In addition to including information on home health employment levels, MedPAC’s report once again urged Congress to slash fee-for-service (FFS) Medicare home health payments.
 
MedPAC has repeatedly argued that home health agency (HHA) margins are too high and that providers have generally been overpaid.
 
“The Commission’s review indicates that FFS Medicare’s payments for home health care are substantially in excess of costs,” the March report states. “Home health care can be a high-value benefit when it is appropriately and efficiently delivered, but these excess payments diminish that value.”
 
Employment outlook
 
Home health agencies across the U.S. have struggled with staffing shortages across multiple roles.
 
The growing demand for in-home care services has partly contributed to the problem. Many reports have also highlighted how home health workers have left their posts for other professions – or retired from the health care workforce altogether.
 
Yet according to Department of Commerce data on the broader medical home care sector, total employment numbers were about 5% higher in July 2023 than compared to before the pandemic. It’s important to note, however, that the medical home care sector also includes hospice, private-duty nursing, pediatric home care agencies and more.
 
“While these data measure employment for a broader category of home care services than Medicare HHAs, the latter comprise a significant share of this sector,” MedPAC wrote in its report.
 
MedPAC notes that reports on home health staffing shortages may only “reflect local labor market conditions” or “other factors not observed in national labor force measures.”
 
MedPAC’s payment recommendation
 
When it comes to cutting home health payment, MedPAC is urging Congress to slash 2025 Medicare base payment rates by 7%.
 
This recommendation comes despite MedPAC recognizing how the cost of delivering home health services has increased.
 
“In 2022, there was an increase of 4% in the cost per 30-day period for freestanding HHAs, a reversal of the trend for 2021, when we observed cost per period decline by 2.9%,” MedPAC wrote in its report.
 
Broadly, MedPAC believes home health agencies can withstand payment cuts because their margins remain high. Home health industry stakeholders have often disputed that claim, describing it as a faulty and flawed calculation…

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That’s A Wrap! CDC Reduces Recommended COVID-19 Isolation Period

Littler | By Devjani Mishara and Alka Ramchandani-Raj

On March 1, 2024, the Centers for Disease Control and Prevention announced that it is updating its COVID-19 guidance and is no longer recommending that individuals who test positive for COVID-19 isolate for five days.  The agency is recommending a new, “unified approach” to respiratory viruses, including not only COVID-19 but also flu and respiratory syncytial virus (RSV). 

Under the new guidance, individuals should monitor themselves for various respiratory virus symptoms, including fever, chills, fatigue, cough, runny nose and headache.  Those who develop such symptoms are recommended to “stay home and away from others,” but also advised that they can return to normal activities “when, for at least 24 hours,” their symptoms are improving and they have not had a fever without the use of fever-reducing medication.  The CDC’s recommendations are now independent of whether an individual actually has tested positive for COVID-19 or any other respiratory virus, and do not include any minimum isolation period.

What does this mean for employers?

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