FED: Home Health to See Rate Decrease in January 2020. What Can You Do?

CMS recently finalized calendar year 2019 and 2020 payment changes for home health agencies. The new payment model, also known as the Patient Driven Groupings Model (PDGM), was finalized on October 31, 2018. There is some good news: We will see Medicare payments increase by 2.2%–or $420 million–based on finalized policies this year. The reimbursement rate increase is the first the home health industry has received in a decade. Unfortunately, the final rule addresses that home health will see a decrease of payments by 6.42% based on the use of “behavioral assumptions” which will take effect January 2020.

Luckily Congress is working with the industry and has introduced corrective legislation into the House and Senate that counteracts this measure. Several of our legislative champions, including Vern Buchanan (R-FL), sponsored one of the three bills introduced, each of which would serve to counteract the “behavioral assumptions” by requiring Medicare to implement adjustments to reimbursement rates only after improper behavioral actions by home health agencies are actually observed affecting Medicate spending rather than assuming those improper activities will occur. While this is a great first step, we need more legislative support to ensure that one of these bills crosses the finish line.

How can you help? The Government Affairs Office (GAO) has been working diligently to meet with key legislators and introduce them to our issues and those of our staff and clients, but we can’t do it alone. BAYADA has been asked to take the lead of home visits for our industry and we need office staff to help us communicate the importance of home care and proper Medicare reimbursement for our services.

To join in our advocacy efforts, please consider meeting with your federal Congressman or Senator through an office visit or home visit. Contact GAO Federal Associate Lindsey Wright today to learn more and to coordinate. The Federal Affairs team has a busy first month of the year and will be making visits to Home Health offices the year to hear what is most important in your office and how we can help.

Upcoming Events

Date Event Location
January 17 Home Health Office Visits CO
January 21-23 Home Health Office Visits AZ
January 24 NHPCO/HAN Board Meeting Phoenix, AZ
January 27-29 Home Care 100 Phoenix, AZ
January 30 HCAOA Board Meeting Tucson, AZ
February 7 PMHC Board Meeting Washington D.C.

CMS Removes HHGM Proposal from Final 2018 Rule

Submitted by David Totaro, Chief Government Affairs Officer (GAO)

Our voices were heard. Thank you and high five to all of our BAYADA office and field employees who recently took action to voice concern about the federal Home Health Groupings Model (HHGM) proposal, which would have resulted in revenue reductions between 4.3% and 17% for BAYADA’s Home Health Specialty Practice. Such significant reductions would have impacted not only Home Health, but BAYADA as a whole.

Yesterday afternoon, the Centers for Medicare and Medicaid Services (CMS) formally indicated that 2018’s Payment Rule does not include the HHGM proposal. CMS indicated that it could not finalize the HHGM proposal at this time based on the comments received on the issue.

BAYADA employees sent more than 3,000 messages to members of Congress urging representatives and senators to take a stand against HHGM. BAYADA joined industry-wide action led by an unprecedented coordinated effort by the Partnership for Quality Home Health Care, Elevating Home and the National Association for Home Care and Hospice (NAHC). This effort spurred 50 US senators and 179 US representatives to reach out to CMS and the US Department of Health and Human Services (HHS) to caution against finalizing HHGM. Through BAYADA’s action on this issue and previous calls to action, BAYADA has shown itself to be one of the strongest advocacy teams in our industry.

While delaying the HHGM proposal does not indicate a permanent withdrawal, it is a clear victory for the home health and home care communities that took immediate action to stop the rule from becoming final. BAYADA and other industry stakeholders will continue to work with CMS to improve the payment model, including participating in discussions with the Congressional Committee on Ways and Means to finalize a potential legislative proposal.

Thank you for your reliability and your dedication to advocating on behalf of our staff and clients.

 

“649 Days Until Medicaid Managed Care Go-live” – Will Medicaid Meet Its Goal in NC?

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

 Last week, I attended the Medical Care Advisory Council (MCAC) meeting where Jay Ludlam the new NC Department of Health and Human Services (DHHS) Assistant Secretary for Medicaid Transformation presented the department’s program design for taking Medicaid into a managed care environment.  Having been on the job for less than three weeks, Ludlam said, “649 days until the Medicaid Managed Care go live date!”  While many steps need to occur before “go live”, including formal approval by Centers for Medicare and Medicaid Services (CMS), the department is aggressively working towards that goal.  I spoke with Mr. Ludlam after the meeting, not only to introduce BAYADA but also to express our concerns with the fast pace, and lack of details for how long-term services and supports will be incorporated into reform.  As you may recall, BAYADA formed a review team and has already submitted comments to the program design. The Government Affairs Office (GAO) will continue to participate in the discussion as the state formulates its plan.  Click to read Jay Ludlam’s complete bio.

Photo of Jay Ludlam link to his bio
Photo of Jay Ludlam link to his bio

Government Affairs Office Directors Attend Fundraiser for US Senator Deborah Stabenow

Submitted by Laura Ness, Director, PA Government Affairs (GAO)

On Tuesday, the Government Affairs Director in Delaware and Maryland Shannon Gahs and I attended an intimate fundraiser for Michigan Senator Deborah Stabenow.  During the fundraiser, we had the chance to thank her for her support of our clients and employees this summer during the intense proceedings leading up to the health care repeal vote.  Senator Stabenow specifically mentioned the thousands of phone calls and emails sent by BAYADA employees and clients and the impact it had.  Our efforts made a difference this summer and helped BAYADA be known as an advocacy leader.

We also had the opportunity to speak with Senator Stabenow regarding the catastrophic home health grouping model proposed by the Centers for Medicare & Medicaid Services (CMS).  he was deeply concerned with the potential cuts.  There’s still time for you to contact your senators and congressman click here to protect our industry.

Shannon Gahs, Senator Stabenow, Laura Ness

North Carolina Budget Released

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

On June 19, lawmakers released a $23 billion budget for 2017-2019. Below are some of the provisions impacting us:

  • Increased Personal Care Services Rate: This provision increases the Medicaid rate for aide services under the Personal Care Services (PCS) program and the Community Alternatives Program for Children (CAP-C). The rate will increase from $13.88 to $15.50 (July 1, 2017) and $15.60 (January 1, 2018) pending approval from the Centers for Medicare & Medicaid Services (CMS). Much to our disappointment, CAP-DA was left out of the budget. A technical issue made it difficult to increase the CAP-DA rate within the established budget neutrality requirement. A rate increase would have meant fewer authorized hours for clients to stay within overall program requirements. BAYADA’s Government Affairs Office continues to work on a solution.
  • Protected the certificate of need (CON) for home health care from being eliminated.
  • Expanded Innovations Waiver slots: This provision added 400 additional Innovations Waiver slots across the state.