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
Luckily Congress is
working with the industry and has introduced corrective legislation into the House
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
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,
weneed 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
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.
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.
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.
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.
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.