August 16, 2022 Washington, DC – A top aging services organization in comments filed to the Centers for Medicare & Medicaid Services (CMS) on its CY2023 Home Health Prospective Payment System (PPS) Proposed Rule warned that older adults and families will pay the price for planned cuts in payments. LeadingAge, the association of nonprofit providers of aging services called out the contradictions between the Biden Administration’s public commitment to ensuring older Americans’ access to home and community-based services and the rule laid out by CMS.

“On the one hand, the Biden Administration has consistently and publicly promoted its commitment to ensuring older Americans’ access to quality aging services – with an emphasis on care in the home and community,” said Katie Smith Sloan, president and CEO, LeadingAge. “Yet in its actions, the Administration is undermining providers’ ability to deliver these critical services. Just as it did with nursing homes, CMS is unfairly assuming all providers are bad actors. This is not acceptable. Despite its proclamations of support, the Administration is harming a critical sector that’s already struggling to meet the nation’s needs. The ultimate victims will be older adults and the families who need care, but are unable to get it.” 

HOME HEALTH PROPOSED RULE SPECIFICS

Of the proposed home health payment rule, LeadingAge told CMS in its comments that “if finalized as proposed, reducing Medicare home health payments by an aggregate 4.2% including a 7.69% negative adjustment to the base payment, coupled with an effort to recoup an additional $2 billion from home health providers, will have a devastating effect on older adults who rely on these services.” 

Homing in on the assumptions CMS used to develop its proposed rule, LeadingAge urged the agency to “base payment policy on evidence,” not erroneous assumptions about providers’ behavior that, with one broad stroke, malign the entire sector. In contrast to CMS’ beliefs, LeadingAge explained, many nonprofit and mission driven agencies have not changed their clinical practice and patient care philosophy to maximize reimbursement since the commencement of the patient-driven grouping model (PDGM) payment system in 2020. They’ve continued to work closely with safety-net hospitals in communities serving higher acuity, often dually eligible, patients who may require more education about their illness and care, and more visits to prevent hospitalizations.  LeadingAge members have not stopped serving, for example, maintenance care patients living with conditions such as Parkinson’s Disease – although their care needs are complex and reimbursements are low. 

“This payment rule does not reflect a real commitment to getting older adults the care and services they need,” said Sloan, adding that CMS must be more transparent about the data it used to determine assumptions of providers’ behavior. If the use of behavioral assumptions continues, it should be done only after CMS’ makes its data public and available for analysis. And, she adds, “we urge CMS to reward good provider behavior, not just penalize bad behavior.”

Key LeadingAge asks of CMS: 

• Delay the permanent payment reductions for at least one year and be dependent on the release of relevant data. 
• Do not implement any temporary retrospective adjustments based on behavior. 
• If CMS moves forward with using behavioral assumptions to inform temporary retrospective adjustments, doing so must be delayed until a methodology to target the adjustment at providers who were truly outliers on the behavioral changes.

“CHILLING MESSAGE” ON THE ENTIRE CARE CONTINUUM 

“As the only association that represents the entire continuum of nonprofit, mission-driven providers serving older adults in Medicare-funded settings including nursing homes, home health and hospice, we take a holistic view of the potential impact of this year’s PPS rules,” said Sloan. The home health PPS rule’s major funding cut, on the heels of insufficient payment increases to nursing homes and hospices, is “a chilling message” being sent by the Biden Administration to the older adults and their families across America seeking access to aging services. 

“From our vantage point, the combined impact of the proposed payment changes and current workforce and inflationary pressures could lead to waves of closures and the inability of providers that remain to take on new referrals. The fragile long-term care ecosystem could simply cease to exist, especially our mission-driven, high-quality members,” Sloan added. “And each referral of service a provider declines, each nursing home that closes, means real pain for older adults and families.” 

Click here to read LeadingAge’s comments in full. 

Comments from LeadingAge home health provider members on the impact of the proposed rule:

“Payment cuts now will be devastating. CMS’ 2.9% inflationary factor assumption is wrong on multiple levels. Our base wages, coupled with sign ons and referral bonuses, increased labor costs by 4.5%. Gas prices, as well as those of personal protective equipment and other supplies, have ballooned. We’ve been making hard decisions for months; we turn away 250 admissions a week because we do not have enough staff. CMS must understand that with this rate cut and staffing challenges, older adults simply will not get much needed care.”

“Our typical home care patients are seniors in their 80s or 90s who often have co-morbidities requiring a combination of services, such as help with bathing and feeding as well as skilled care, such as medication management and/or rehabilitation therapy. Demand for care at home has grown tremendously and continues as we navigate the pandemic and as our population ages. Labor shortages make it more difficult to hire the people we need to provide the care that’s necessary. We are struggling to piece together care for home care cases because of fierce competition for staff.

Wages for home care professionals – aides, physical therapists, social workers, nurses – are tied to reimbursement rates. Any reduction to reimbursement, as proposed in this rule, will erode our ability to compete for staff. The outcome is simple: no staffing, no services – and that will surely lead to a crisis in caring for our nation’s aging population.”

“The $810 million in proposed cuts will be devastating if implemented. We work closely with one of our region’s critical access, or safety net, hospitals. The patients referred to us are – increasingly – more acute, which means they need more services, not less, at a time when workforce challenges are already straining our ability to serve all who need help. The impact of decreased payment rates will be dire: fewer admissions, more people waiting longer for care.” 

We represent more than 5,000 nonprofit aging services providers and other mission-minded organizations that touch millions of lives every day. Alongside our members and 38 state partners, we use applied research, advocacy, education, and community-building to make America a better place to grow old. Our membership, which now includes the providers of the Visiting Nurse Associations of America, encompasses the continuum of services for people as they age, including those with disabilities. We bring together the most inventive minds in the field to lead and innovate solutions that support older adults wherever they call home. For more information visit leadingage.org.