By Kaitlyn Mattson | October 7, 2018
The home health industry has won another victory in Washington, D.C., in its battle against certain parts of the Patient-Driven Groupings Model (PDGM) and shift toward a more pre-acute care identity.
Sens. Susan Collins (R-Maine), Bill Nelson (D-Fla.) and Debbie Stabenow (D-Mich.) introduced the Home Health Payment Innovation Act — S. 3545 — on Wednesday. If passed, the bill would amend the Social Security Act and loosen a homebound requirement for Medicare beneficiaries in Medicare Advantage plans.
This bill — along with others introduced over the last month, including H.R. 6932 and S. 3458 — is another effort on Capital Hill to reshape proposed home health payment reform from the Centers for Medicare & Medicaid Services (CMS).
CMS released details of PDGM in July. In its initial announcement, CMS highlighted how PDGM is meant to better align reimbursement with patient needs and set a Jan. 1, 2020 implementation date.
Many home health leaders have been pointing to issues within the rule, including the behavioral adjustments, along with changes to the Low Utilization Payment Adjustment (LUPA) and how case mix weight is determined.
“S. 3545, S. 3458, and H.R. 6932 share identical language surrounding payment protections — by requiring any behavioral-based payment changes to be grounded in evidence — and observed data,” Keith Myers, CEO of LHC Group (Nasdaq: LHCG) and chairman of The Partnership for Quality Home Healthcare, told Home Health Care News via email. “S. 3545 also includes a provision that would permit the waiving of the homebound regulatory requirement … This flexibility is needed and necessary as home health is an important part of keeping patients out of higher levels of care and institutional settings.”
The Partnership has come out in support of the Home Health Payment Innovation Act. The D.C.-based Partnership is an organization that works with government officials to ensure access to home health care services for all Americans.
“S. 3545 would help to ensure greater stability in the new home health payment model … This is a data driven approach, consistent to what CMS is doing with the skilled nursing facility new payment system — and is a more responsible, evidence-based way to transition to a new payment model,” Myers said.
Certifying that a patient is eligible for the Medicare home health benefit requires that a patient be homebound, confined to the home, or their periods outside of the home are infrequent and short in duration.
“Loosening the homebound requirement would enable greater flexibility for the patients we care for, which would improve the quality of care and enhance home health’s ability to participate in new models of care, and Medicare managed care,” Myers said. “It would also allow home health providers to reach those in need of skilled home [health care] services who are currently restricted from receiving home health services because of a strict regulation that limits the capacity of home health to be part of the care of needy Medicare patients.”
The bills have received support from Amedisys (Nasdaq: AMED), the National Association for Home Care & Hospice (NAHC) and others across the industry.
“Americans have listed health care as the most important problem facing our country should come as no surprise,” Sen. Collins, said during a hearing on reducing cost and enhancing delivery of health care. “Health care is a deeply personal, complex issue that affects each and every one of us and comprises one-sixth of the American economy. If we want to improve the affordability and accessibility of health care, as well as the sustainability of our entitlement programs, we simply must get a handle on cost.”
Written by Kaitlyn Mattson