In the News

Dems Want to Tax High Earners to Protect Medicare Solvency

Associated Press | By ALAN FRAM
 
WASHINGTON (AP) — Senate Democrats want to boost taxes on some high earners and use the money to extend the solvency of Medicare, the latest step in the party’s election-year attempt to craft a scaled-back version of the economic package that collapsed last year, Democratic aides told The Associated Press.
 
Democrats expect to submit legislative language on their Medicare plan to the Senate’s parliamentarian in the next few days, the aides said. It was the latest sign that Majority Leader Chuck Schumer, D-N.Y., and Sen. Joe Manchin, D-W.Va., could be edging toward a compromise the party hopes to push through Congress this summer over solid Republican opposition. Manchin scuttled last year’s bill.
 
Under the latest proposal, people earning more than $400,000 a year and couples making more than $500,000 would have to pay a 3.8% tax on their earnings from tax-advantaged businesses called pass throughs. Until now, many of them have been using a loophole to avoid paying that levy.
 
That would raise an estimated $203 billion over a decade, which Democrats say would be used to delay until 2031 a shortfall in the Medicare trust fund that pays for hospital care. That fund is currently projected to start running out of money in 2028, three years earlier.
 
Most U.S. businesses are pass throughs, which include partnerships and sole proprietorships and range from one-person law practices to some large companies. Owners count the profits as income when they pay individual income taxes, but such companies do not pay corporate taxes — meaning they avoid paying two levels of taxation.
 
Democrats this week also sent the parliamentarian a separate 190-page piece of the emerging Schumer-Manchin compromise that would lower prescription drug costs for patients and the government. Provisions include requiring Medicare to negotiate drug prices, limiting beneficiaries’ out-of-pocket costs to $2,000 annually and increasing federal subsidies for copays and premiums for some low-income people.

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Biden-Harris Administration Takes Action to Expand Access to Emergency Care Services in Rural Communities

CMS proposes new rule that creates a pathway for rural hospitals and critical access hospitals to increase access to emergency and outpatient care

Today, as part of the Biden-Harris Administration’s ongoing effort to strengthen rural health, the Centers for Medicare & Medicaid Services (CMS) is releasing a new proposed rule protecting access to emergency care and additional outpatient services for people in rural communities. CMS is establishing the Conditions of Participation (CoPs) for Rural Emergency Hospitals (REHs). The proposed rule will allow small rural hospitals to seek this new health care provider designation and provide continued access to emergency services, observation care, and additional medical and outpatient services. In accordance with the statutory legislation, REHs will be eligible to receive payment for services provided on or after January 1, 2023. This is a significant step in building on the Administration’s efforts to reduce health care disparities and maintain access to services in rural communities.

Rural communities represent a fifth of the U.S. population, and the Department of Health and Human Services (HHS) is committed to improving health outcomes and promoting health equity in rural America. Since 2010, 138 rural hospitals have closed — with a record-breaking 19 hospitals closing in 2020 alone. These closures occur disproportionately within communities with a higher proportion of people of color and communities with higher poverty rates. Rural communities experience shorter life expectancy, higher mortality, and have fewer local health care providers, leading to worse health outcomes than in other communities. Rural hospital closures deprive people living in rural areas of crucial services, including access to emergency care.

“The availability of the new Rural Emergency Hospital provider type will maintain access to essential health care services and help to reduce disparities in rural communities,” said CMS Administrator Chiquita Brooks-LaSure. “CMS is committed to advancing health equity, driving high-quality person-centered care, and promoting the sustainability of our programs. Today’s action to strengthen rural health furthers our goal of ensuring everyone served by our programs the has access to quality, affordable health care.”

To address these concerns, CMS is implementing a new Medicare provider designation called REHs, which will provide an opportunity for small rural hospitals and CAHs to right-size their service footprint and avoid potential closure so they can continue to provide essential services for their communities. The REH provider type was established by the Consolidated Appropriations Act of 2021 to address the growing concern over closures of rural hospitals. . .

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For more information on the Rural Emergency Hospital and Critical Access Hospital Conditions of Participation, visit: https://www.federalregister.gov/public-inspection/current

To read the Fact Sheet on the Rural Emergency Hospital and Critical Access Hospital Conditions of Participation, visit: https://www.cms.gov/newsroom/fact-sheets/conditions-participation-rural-emergency-hospitals-and-critical-access-hospital-cop-updates-cms-3419.

To read the Fact Sheet on HHS actions to strengthen rural health, click here

 

FDA Advisers Recommend Updating COVID Booster Shots for Fall

Associated Press | By Lauran Neergaard and Matthew Perrone

At least some U.S. adults may get updated COVID-19 shots this fall, as government advisers voted Tuesday that it's time to tweak booster doses to better match the most recent virus variants.

Advisers to the Food and Drug Administration wrestled with how to modify doses now when there's no way to know how the rapidly mutating virus will evolve by fall — especially since people who get today's recommended boosters remain strongly protected against COVID-19's worst outcomes.

Ultimately the FDA panel voted 19-2 that COVID-19 boosters should contain some version of the super-contagious omicron variant, to be ready for an anticipated fall booster campaign.

"We are going to be behind the eight-ball if we wait longer," said one adviser, Dr. Mark Sawyer of the University of California, San Diego.

The FDA will have to decide the exact recipe, but expect a combination shot that adds protection against either omicron or some of its newer relatives to the original vaccine

"None of us has a crystal ball" to know the next threatening variant, said FDA vaccine chief Dr. Peter Marks. But "we may at least bring the immune system closer to being able to respond to what's circulating" now rather than far older virus strains.

It's not clear who would be offered a tweaked booster — they might be urged only for older adults or those at high risk from the virus. But the FDA is expected to decide on the recipe change within days and then Pfizer and Moderna will have to seek authorization for the appropriately updated doses, time for health authorities to settle on a fall strategy.

Current COVID-19 vaccines have saved millions of lives globally. With a booster dose, those used in the U.S. retain strong protection against hospitalization and death but their ability to block infection dropped markedly when omicron appeared. And the omicron mutant that caused the winter surge has been replaced by its genetically distinct relatives. The two newest omicron cousins, called BA.4 and BA.5, together now make up half of U.S. cases, according to the Centers for Disease Control and Prevention.

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President's Message

Posted: June 29, 2022

So, the 2023 Proposed Final Rule is upon us. And it is ugly. The long and short of it is a 4.2% decrease in reimbursement versus 2022. This is along with the onset of Home Health Value Based Purchasing AND OASIS E on January 1, 2023. Yes, I agree that it looks like CMS is asking more of us and paying us less. And CMS says that they are paying the Home Health industry 7.69% more under PDGM than under the previous iteration of PPS, but that PDGM is supposed to be budget-neutral. CMS is arguing that this can be attributed mostly, if not completely, to “behavioral changes”—changes in how agencies answer the OASIS questions, and changes in how agencies assign ICD-10 codes. We as an industry beg to differ, but hold that thought for a moment.

What is APTA Home Health doing about this? I have already met with APTA’S Regulatory Affairs department once to begin strategizing. And our Government Affairs Committee will meet this week to further discuss this. All this despite the fact that we are all still digesting the entire Rule. I have not yet been able to read it in its entirety. I expect it to make for stimulating reading on the beach this week.

What can YOU do in response to this proposal? USE YOUR VOICE! Shortly, there will be a sample comment letter that you will be able to utilize. Keep an eye out for that in your e-mail, on Facebook, and on Twitter. The more comments that CMS receives from us, the more stock they put in our views. If you have hard data to prove that our clients are more ill, more complex, and more resource-intensive than CMS believes them to be, please come forward with it if you are able to! We need the statistics and data to prove CMS wrong.

We know that our clients and the majority of older Americans want to stay at home, and we know that the services that we provide in the home are vital, and save CMS and the health care system as a whole millions of dollars. We need to speak out NOW to be able to continue providing those services and be reimbursed in a manner consistent with our value.

Sincerely, 

 


 Phil Goldsmith
 President
 APTA Home Health

 

 

Home Health Proposed Rule Results in $810M Decrease in Payments

WASHINGTON, D.C. (June 21, 2022)—The annual proposed rule for Medicare home health services includes an estimated 4.2% or $810 million decrease in aggregate payments, said the Centers for Medicare and Medicaid Services (CMS) in its fact sheet on the rule. The rule would apply to calendar year 2023. 

This decrease reflects the effects of: the proposed 2.9% home health payment update percentage ($560 million increase); an estimated 6.9% decrease that reflects the effects of the proposed prospective permanent behavioral assumption adjustment of -7.69% ($1.33 billion decrease); and an estimated 0.2% decrease that reflects the effects of a proposed update to the fixed-dollar loss ratio (FDL) used in determining outlier payments ($40 million decrease).  

Overall, the rule presents serious concerns for the home health community as it includes significant proposed rate reductions to account for the change in the payment model in 2020, the National Association for Home Care & Hospice (NAHC) said. Medicare law requires CMS to make permanent and temporary adjustments intended to ensure that the transition to the Patient Driven Groupings Model (PDGM) is budget neutral in comparison to expected Medicare spending on the 2019 payment model. 

“We are extremely disappointed in the CMS proposed rule issued today. The stability of home health care is at risk because of CMS proposing the application of a fatally flawed methodology for assessing whether the PDGM payment model led to budget neutral spending in 2020 and later years,” stated William A. Dombi, president of NAHC. “That has been made clear to CMS in the 2021 rulemaking and in multiple discussions since. With significantly rising costs for staff, transportation, and more, home health agencies across the country cannot withstand the impact of the proposed rate cut. Reliable analyses proves that PDGM underpaid home health agencies. We will be taking all steps to protect the home health benefit as this proposed rule advances and have fully prepared for congressional action and more.” 

“Considering that access to home-based care has become increasingly important to the health and safety of American seniors, it is very troubling that CMS would propose such steep rate cuts for next year and potentially even deeper cuts in the future,“ said Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare. “If implemented as proposed, this payment adjustment will jeopardize the stability of this vital sector and risk seniors’ access to Medicare home health services.”

“What we see in the proposed rule is the equivalent of a declaration of war against home health agencies and the 3 million plus patients they serve. To believe this will have no impact on patients is to live in a bubble,” Dombi stated.

The rule also contains:

  • A net 2.9% inflation update (3.3% market basket index – 0.4% productivity adjustment)—This is a strikingly low inflation update given that current inflation is at a 20-year high, nearing double digits.
  • A 7.69% budget neutrality adjustment allegedly related to provider behavior changes triggered by PDGM
  • An alleged $2 billion overpayment in 2020 and 2021. CMS proposed withholding any adjustment at this time to reconcile the alleged overpayment.
  • Recalibration of the 432 case mix weights—Recalibration has been done annually to account for changes in case-specific resource and cost changes.
  • Modification of the LUPA thresholds Institution of a 5% cap on negative changes in the area-specific wage index.

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