CMS Proposed Rule Maintains 4.36% Assumption-Based Rate Cut to Medicare Home Health Despite Sector Concerns
Summary
Patient Driven Groupings Model (PDGM) Behavioral Rate Cuts Despite concerns from lawmakers and providers – as well as a recent data analysis of 2020 Medicare claims data showing that assumptions used to justify the 2020 and 2021 cuts do not reflect actual provider behavior – CMS again proposed to maintain the 4.36% payment rate adjustment under the Patient Driven Groupings Model (PDGM) for another year. CMS’ data also show that Medicare home health spending fell significantly below the budget neutral level that Congress mandated for two consecutive years. “We look forward to providing comment and working with CMS to make the new HHVBP model a success by building off lessons learned during the nine-state demonstration program,” added Cunningham. However, while home health leaders caution against extending these unsubstantiated cuts for the third consecutive year, into 2022, they commend CMS’ inclusion of the nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) Model in today’s proposed rule.Patient Driven Groupings Model (PDGM) Behavioral Rate CutsDespite concerns from lawmakers and providers – as well as a recent data analysis of 2020 Medicare claims data showing that assumptions used to justify the 2020 and 2021 cuts do not reflect actual provider behavior – CMS again proposed to maintain the 4.36% payment rate adjustment under the Patient Driven Groupings Model (PDGM) for another year. “In order to ensure continued care delivery for Medicare beneficiaries, PQHH strongly urges CMS to eliminate the behavioral adjustment for home health payment rates for CY 2022 and reconcile any unsupported payment cuts for CYs 2020 and 2021,” added Cunningham.The HHPPS proposed rule comes on the heels of a new analysis compiled by health economists at Dobson DaVanzo & Associates , which demonstrates, using a full set of 2020 Medicare claims data, how the assumptions CMS made when implementing the PDGM cut last year did not come to fruition, thus refuting the justification for the reimbursement reductions.