At any time, the Centers for Medicare & Medicaid Services (CMS) will officially publish the final payment rule for home health care.
As providers await their arrival, many of them are gathered in St. Louis for the annual conference of the National Association for Home Care and Hospice (NAHC). If the final rule is as bad, or almost as bad, as the proposed rule, it will be a dark day for the industry.
However, it will not be for lack of effort.
“The main thing we’re looking at is the 7.69% rate cut, will it happen or not? NAHC President William A. Dombi told the conference on Sunday. “We have participated in the most intense defense effort that I have experienced in my life. And I’ve been around for a few years advocating. The effort we have underway includes all forms of promotion”.
Unlike previous years where a certain provision may have been a cause for concern to providers in the proposed rule, this year’s rule, if finalized as proposed, will threaten its very existence.
Dombi noted that roughly 51% of home health care providers would be operating in the red if the rate reduction were to materialize by 2023, according to an NAHC analysis.
That number also assumes that the agencies will not change the way they do business. Of course, they will have to if there is an aggregate 4.2% decrease in home health care rates.
There is also some concern that the estimated 4.2% cut is more severe than CMS is letting on.
“First of all, just that added impact,” Scott Pattillo, chief strategy officer for Homecare Homebase, told Home Health Care News earlier this month. CMS predicted that this year’s proposed rule would result in a 4.2% cut in the industry. Across all of our aggregated models, using 36% of the data, which we think is a pretty good cross-section, we’re seeing a 5% cut in reimbursement. It’s going to create an even bigger impact on access to care.”
The prospect of that is why NAHC and others have taken that three-pronged approach to defense: the regulatory front, with Congress over the Home Health Access Preservation Act, and preparing for a legal battle by the time the law is finalized. rule.
Dombi also noted that there is significant support for the home health industry in its fight against rate cuts in Washington, DC. That support is on both sides of the aisle, both in Congress and in the Senate.
“Our allies in Congress have stepped beyond anything I’ve experienced,” Dombi said.
Although a proverbial dark cloud hung over the speech, the preparation and advocacy the industry has taken has given Dombi and other leaders hope as the final rule draws near.
“The CMS administrator has probably had endless conversations at this point with members of Congress, with us and with many others,” Dombi said. “We are on the edge of our seats waiting to see what happens. If we give a blind forecast, the forecast is that we think we are in the game. We have a meeting scheduled for Thursday of this week with the director of the Office of Management and Budget. They wouldn’t give us that meeting if they didn’t want to hear what we had to say again.”
The aforementioned legal battle would come after a negative final rule is finalized and possibly even after those tariffs are implemented in 2023.
Given the recent success of hospitals fighting a fee cut in court, along with other general legal trends in the US, home health leaders are right to think they would have a strong case against CMS. and the US Department of Health and Human Services.
“We always look at litigation as a last resort,” Dombi said. “At the moment, we have thoroughly prepared the legal arguments presented both on the regulatory front and before Congress along the way, and we will do everything possible to protect their interests. The one thing that I think these defense personnel do as well as anyone, if not better than anyone else, is that they don’t give up and you don’t give up either. Therefore, we look forward to working as a team with you as we need to in the future.”