[Updated] CMS Proposes 2.2% Decrease To Home Health Provider Medicare Payments in 2024

Home Health Care news | By Andrew Donlan

The U.S. Centers for Medicare & Medicaid Services (CMS) published its FY 2024 home health proposed payment rule Friday. 

For next year, CMS is proposing to decrease aggregate home health payments by 2.2%, or an estimated $375 million less compared to 2023 levels. The draft is expected to be officially published in the Federal Register on July 10.

The news is an expected but disappointing development for home health providers.

“The $375 million decrease in estimated payments for CY 2024 reflects the effects of the CY 2024 proposed home health payment update percentage of 2.7% ($460 million increase), an estimated 5.1% decrease that reflects the effects of the permanent behavioral assumption adjustment (-$870 million) and an estimated 0.2% increase that reflects the effects of an updated FDL ($35 million increase),” CMS wrote in the draft.

A -3.925% permanent rate adjustment was already implemented in 2023.

Yet another round of payment cuts are likely to have devastating effects on the home health industry at large.

“We continue to strenuously disagree with the budget neutrality methodology that CMS employed to arrive at the rate adjustments,” William A. Dombi, the president of the National Association for Home Care & Hospice (NAHC), said in a statement shared with Home Health Care News. “Overall spending on Medicare home health is down, fewer patients are receiving care, patient referrals are being rejected because providers cannot afford to provide the care needed within the payment rates, and providers have closed their doors or restricted service territory to reduce care costs. If the rate was truly budget neutral, we would not see these actions occurring.”

In order to curb future rate cuts – including in 2024 – Sens. Debbie Stabenow (D-Mich.) and Susan Collins (R-Maine) introduced the Preserving Access to Home Health Act of 2023 earlier this month.

If passed, the bill would strip CMS of some of its payment-rate setting power. It would also force The Medicare Payment Advisory Commission (MedPAC) to consider Medicare Advantage (MA) payment rates in its reports.

“We now turn to Congress to correct what CMS has done and prevent the impending harm to the millions of highly vulnerable home health patients that depend and will depend in the future on this essential Medicare benefit,” Dombi said...

Read Full Article to see what else is in the proposed rule. 

NAHC Sues Medicare to Preserve the Home Health Service Benefit

NAHC

The National Association for Home Care and Hospice (NAHC) filed a lawsuit against the Centers for Medicare and Medicaid Services (CMS) and the United States Department of Health and Human Services (HHS) challenging the validity of a change in Medicare home health payment that reduced rates by 3.925% in 2023 with significant additional cuts expected over the next several years.  CMS has proposed an additional 5.653% permanent rate cut to begin in 2024 based on the same challenged payment methodology.

The lawsuit argues that Medicare is required to institute the payment model changes in a budget neutral manner rather than to inflict rate cuts that have precipitated services limitations or access to care.  Until recently, nearly 3.5 million Medicare beneficiaries received home health services annually.  Since the new payment model began in 2020, over 500,000 fewer Medicare patients have accessed home health services.

“We have done everything possible to get Medicare to understand the disastrous consequences of its actions.  We have presented hard facts, deep legal analyses, and extensive data to Medicare that demonstrate the errors in its policies to no avail.  As a last resort, we have filed this lawsuit to protect Medicare beneficiaries and the home health agencies that care for them.” stated William A. Dombi, President of NAHC.

“Home Health agencies again must withstand billions of dollars in payment cuts as cost of care continues to rise and still be expected to deliver the care to which our patients are entitled to as a Medicare benefit.”  added Ken Albert, Chairman of NAHC, and CEO of Androscoggin Home HealthCare + Hospice. “Since these cuts took effect in January, providers have reduced service areas, turned away thousands of patients, and halted the use of innovative technologies in order to stay afloat and serve some patients,” he noted.

The lawsuit was filed in the U.S. District Court for the District of Columbia.  It alleges that CMS and HHS promulgated an illogical and invalid methodology in determining whether expenditures stemming from payment rates established in 2020 were “budget neutral” in comparison to the estimated expenditures that would otherwise have occurred under the previous payment model.  Budget neutrality is required under a 2018 law that mandates certain payment system reforms.

Data from the Congressional Budget Office (CBO) highlights the extent of Medicare’s error.  Following the 2018 enactment of the payment reform legislation, CBO projected 2023 Medicare expenditures at $23 Billion. In May 2023, CBO revised its 2023 projections downward to only $16 Billion.

The lawsuit seeks declaratory and injunctive relief including a reversal of the rate adjustments in the 2023 rule and requirement that Medicare implement the budget neutrality mandate consistent with the law.

New Member Benefit Provides Medicaid Payment Information

APTA's State Medicaid Payment Rate Guide is an expansive resource that can help members understand and participate in the program.

News

Date: Friday, June 16, 2023

Medicaid is a huge program, serving an estimated 77.3 million Americans. And as just about any PT familiar with the program can tell you, the system can be a challenging one to navigate for providers.

That challenge just got a little easier for APTA members.

Now available: the APTA State Medicaid Payment Rate Guide, available for free as a member benefit, that helps PTs navigate the Medicaid landscape.

Offered in the form of an Excel spreadsheet, this rich resource serves up in-depth information on Medicaid fee-for-service payment rates for PT services provided by state Medicaid programs. The resource is not only a useful tool for individual members, but because it offers comparisons among states, it also can be an aid to state APTA chapters advocating for payment increases.

The guide offers payment rates for selected CPT codes as well as links to the Medicaid manuals for all 51 U.S. jurisdictions, and includes a terminology look-up, data dictionary, and frequently asked questions, among other features. The resource is also scalable, allowing users to zero in on specific states, codes, or other information. There's even a brief instructional video to help you familiarize yourself with the guide's features.

APTA President Roger Herr, PT, MPA, sees the guide as an important step in making Medicaid more approachable for PTs, and in turn increasing patient access to needed care.

"By helping our members better understand Medicaid, we're empowering them to participate fully in this crucial program that provides care to families, children, pregnant individuals, the elderly, and people with disabilities," Herr said. "PT services are needed in Medicaid, and APTA wants to do whatever we can to support access."

U.S. Supreme Court Clarifies Employer’s Religious Accommodation Obligations

• The U.S. Supreme Court has announced its decision in Groff v. DeJoy, a long-awaited decision explaining employers’ obligations under Title VII to reasonably accommodate employees’ religious beliefs, observances, and practices.

• In the case, a former United States Postal Service (USPS) mail carrier, Gerald Groff claimed that he was unlawfully denied his requested religious accommodation to not work Sundays. The USPS tried to find other carriers to cover Groff’s Sunday shifts, but because of a shortage of rural carriers, it often failed. Groff requested that the USPS exempt him from Sunday work, but the USPS declined, stating that his requested accommodation would lead to undue hardship for the USPS.

• Under Title VII of the Civil Rights Act, employers are required to reasonably accommodate employees whose sincerely held religious beliefs or observances conflict with work requirements, unless doing so would create an undue hardship for the employer. With no statutory definition of “undue hardship”, courts have relied on the Supreme Court’s decision in TWA v. Hardison, 432 U.S. 63 (1977), to determine the parameters of the term. In Hardison, the Court stated that requiring an employer “to bear more than a de minimis cost in order to give [an employee] Saturdays off is an undue hardship.” In Groff, the Court changed the test. According to the Court, it now “understands Hardison to mean that ‘undue hardship’ is shown when a burden is substantial in the overall context of an employer’s business.” The Court declined to incorporate the undue hardship test under the Americans with Disabilities Act which requires significant difficulty and expense.

If employers have any questions or concerns, we recommend they contact us to ensure compliance. For assistance, contact us at 423-764-4127 or by email at [email protected]