August 26, 2024 Washington, DC — In comments submitted to the Centers for Medicare and Medicaid Services (CMS) on the CY2025 Home Health Proposed Payment Rule, LeadingAge, the association of nonprofit, mission-driven providers of aging services, including home health, expressed deep concern over the impact of the proposed 1.7% rate reduction and provided detailed recommendations on proposed policy changes, including the additional negative 4.07% adjustment and labor market delineation adjustments, that impact payments to providers. In addition, LeadingAge’s feedback also focused on numerous other issues, including changes to the conditions of participation, and extending requirements for nursing homes submitting COVID data to the National Healthcare Safety Network (NHSN) system.
“If implemented as proposed, CMS will have cut home health payment permanently by nearly 9% in three years – only two short years after the COVID-19 pandemic dismantled health care as we know it. Reducing payment reduces access to services, which is a direct contradiction of the Biden administration’s oft-stated goal of expanding home and community based services,” said Katie Smith Sloan, president and CEO, LeadingAge.
Sloan adds: “These cuts are coming at times when demand for the services our nonprofit and mission-driven members provide – and the cost to deliver that care – are rising. Continuing to implement these cuts will have a devastating effect on older adults who need care. The combined impact of the proposed payment changes and current workforce and inflationary pressures will lead to more closures and the inability of providers that remain to take on new referrals.”
LeadingAge’s payment-related requests:
- CMS delay the proposed payment reduction for the third year, with the recognition that it will contribute to the growth of the temporary payment adjustments.
- CMS to reduce the permanent cap on home health wage index decreases to 2% during the CBSA transition year of CY2025 instead of the normal 5% cap on reductions.
Extending requirements for nursing homes to report COVID data to the Centers for Disease Control & Prevention (CDC) through the National Healthcare Safety Network (NHSN) system: While CMS maintains “information sharing across the health care ecosystem helps the health care community to prepare for, and effectively respond to, respiratory illness surges in ways that maintain the safety and availability of critical care services,” LeadingAge observed that NHSN data could not be supporting this information sharing across the health care ecosystem, since nursing homes are the only setting that continues to be required to report such data. While CMS proposes that nursing homes would continue to report at pandemic-level frequencies, reporting requirements ended completely for hospitals on May 1, 2024, and dialysis centers have not been required to report since the end of the public health emergency in May 2023. For nursing homes, reporting requirements are unnecessary, duplicative, and result in no direct benefit to nursing home residents or the staff who care for them. CMS has been unable to adequately justify the continued reporting of respiratory illness data by nursing homes to NHSN on a weekly basis and LeadingAge advocates that these reporting requirements be allowed to expire on December 31, 2024.
Changes to Conditions of Participation (CoPs): LeadingAge adamantly opposes the addition of a condition of participation for home health agencies to establish an acceptance to service policy. Over the last several years, LeadingAge relayed concerns to CMS and MedPAC about the referral rejection rate in home health including extensive documentation in our CY2024 Home Health Proposed Rule comments. We are extremely disappointed with the resulting proposal. Without any request for information (RFI) first to understand the problem further or any analysis of CMS data to identify the root cause, CMS is proposing additional administrative burdens to home health agencies instead of effectuating true changes in access.
LeadingAge also disagrees with CMS that this proposal is consistent with the “Ensuring Access to Medicaid Services.” Maintaining adequately trained staff and compensating them appropriately is costly. Creating CoPs in the Medicare program that overreach on behalf of Medicaid, where neither the federal government nor the provider have the ability to increase Medicaid rates is inappropriate. The fact that Medicaid is a loss-leader is not the fault of providers, nor should they be penalized for their inability to serve additional Medicaid participants simply because they can serve some.
