On November 1,  2024, the Centers for Medicare and Medicaid Services (CMS) released the Home Health Prospective Payment System (HH PPS) final rule for CY2025 containing home health payment cuts, condition of participation changes, and NHSN reporting changes.

“Though the final payment rule released today is a net aggregate payment increase of 0.5%, or $85 million, this number must be put into context. Although CMS has spread out the baseline cuts, the rule nonetheless finalizes a -1.975% permanent projected adjustment. This brings us to a nearly 9% permanent cut to home health payment since 2023. At the same time, a $4.5 billion temporary adjustment looms.  This combined reduction in payment will harm older adults and families in need of care and the providers who are doing their best to deliver it. Our nonprofit, mission-driven agency members are at risk. We are already seeing provider closures. This is simply unsustainable,” says Katie Smith Sloan, LeadingAge president and CEO, in a press statement reacting to the news.

Read more here.

On October 1, 2024 the Office of Management and Budget (OMB) received the CY2025 Home Health Final Rule. This is the final step in federal review of rule making. We anticipate this rule will be posted the end of October.

On September 25, a letter led by Rep. Ritchie Torres (D-NY) from New York state’s congressional delegation went to President Biden, Director of the Office of Management and Budget (OMB) Shalanda Young, and Administrator of the Centers for Medicare & Medicaid Services (CMS) Chiquita Brooks-LaSure to express disapproval of CMS’ CY2025 proposed payment rule. The delegation expressed concerns that the payment rule’s proposed cuts would threaten home healthcare providers’ ability to continue to care for the nation’s older adults and people with disabilities; exacerbate an existing labor shortage within the healthcare industry, and disproportionately impact vulnerable and minority communities. LeadingAge’s comments to CMS also opposed the proposed rule’s cuts to home health services. The CY2025 Home Health Final Rule has not yet been received by OMB. Historically, the final rule is published the last week of October.

LeadingAge submitted comments on the CY2025 Home Health Proposed Rule on August 26. LeadingAge argued against the proposed cut, argued for greater flexibility in completing the OASIS especially with the potential addition of more social determinates of health measures.

“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, LeadingAge president and CEO, in a press release.

In our comments, we also strongly articulated our objections to the proposed COPs and offered other suggestions for dealing with the delays in accessing home health. LeadingAge opposed provisions to expand and make permanent NHSN reporting requirements for nursing homes, pointing out that this data no longer serves the same purposed as when first implemented and reminding CMS that nursing homes will continue tracking and sharing data on respiratory illnesses as appropriate based on existing requirements for the Infection Prevention and Control and Quality Assurance and Performance Improvement programs.

The proposed Calendar Year 2025 Home Health Payment proposed rule was published to the Federal Register on July 1, 2024. The rule proposes a 1.7% decrease in payment and also includes new Conditions for Participation regarding an acceptance to service policy. LeadingAge will be submitting comments on the proposed rule, and we encourage members to do so as well. Comments on the rule are due to the Federal Register on August 26 and we created a new members-only resource that includes tips and assistance for developing and submitting comments.

The home health payment proposed rule that was published at the end of June included provisions that apply to nursing homes. The provisions relate specifically to nursing home reporting through National Healthcare Safety Network (NHSN) and would 1) make reporting permanent, 2) expand reporting to encompass other respiratory viruses such as flu, pneumonia, and RSV, and 3) give the Secretary of Health & Human Services (HHS) flexibility to require changes to reporting without notice-and-comment rulemaking. Despite this being a home health rule, nursing homes can and should comment to oppose these provisions. Comments are due by 5pm ET August 26. Check out this resource for help developing and submitting your comments.

LeadingAge will host a special Home Health Member Network meeting to discuss the recently released CY2025 Home Health Proposed Rule on Thursday, July 18 from 2 to 3:30 p.m. ET. The discussion will last 90 minutes and cover payment, quality reporting, home health value-based purchasing, proposed conditions of participation changes for acceptance to service policy, and multiple requests for information.

To join this special event, members can register here.

Full analysis of the proposed CY2025 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Requirements Proposed Rule, released on the Federal Register public inspection site on June 26^th and scheduled for publication in the Federal Register on July 1st, can be found in this article.

As the Centers for Medicare and Medicaid Services (CMS) has done in the past, the agency slipped reporting requirements impacting nursing homes into the Calendar Year (CY) 2025 Home Health Prospective Payment System (PPS) proposed rule. The proposals to extend weekly National Healthcare Safety Network (NHSN) reporting for nursing homes would, if included in the final rule, extend nursing homes’ reporting requirements indefinitely. The proposed rule contains a modification of reporting requirements that would expand required elements to include data on influenza and respiratory syncytial virus (RSV). It also contains provisions that would allow CMS to require additional reporting in the future without notice and comment rulemaking should it be determined that an acute respiratory illness public health emergency is occurring or a significant threat of one exists. This action is in direct contradiction of LeadingAge’s May 31 advocacy which “urges CMS to allow reporting requirements to expire on December 31, 2024, without modification or further requirements for nursing home COVID data reporting through the NHSN system” and to significantly modify NHSN reporting.

Read more on CMS’ proposal here. As part of the CY 25 Home Health proposed rule, these provisions have a 60-day comment period during which LeadingAge will be submitting comments.

In a June 26 statement, LeadingAge President and CEO Katie Smith Sloan pointed out that the CY2025 Home Health Proposed Payment Rule, which includes a proposed cut of 1.7% to home health providers, puts older adults and their families at risk of losing access to needed care and services.

“Put today’s action from the Centers for Medicare and Medicaid Services (CMS) into context: Registered nurses (RNs) are a core component of home health care,” Sloan said. “Our mission-driven and nonprofit members battle daily in a very competitive labor market to recruit and retain RNs, which are in short supply. Coupled with the Biden administration’s nursing home staffing rule’s nurse-onsite 24/7 component, already stiff competition for RNs will only grow.”

Read the entire statement here.

Please make sure to register for the Home Health Member Network. Our next meeting will be Tuesday, July 2, at 2 p.m. ET and we will be discussing the proposed rule.

The Office of Management and Budget (OMB) completed its review of the CY2025 Home Health Proposed rule on Monday, June 24. LeadingAge anticipates the rule will be published for public inspection on June 26 and we will notify members as soon as it becomes available.

Please make sure to register for the Home Health Member Network. Our next meeting will be Tuesday, July 2, at 2 p.m. ET and we will be discussing the proposed rule.

The Centers for Medicare and Medicaid Services submitted CY 2025 Home Health Prospective Payment System Rate Update and Home Infusion Therapy and Home IVIG Services Payment Update (CMS-1803) proposed rule to the Office of Management and Budget (OMB) for review on April 26.

OMB’s review is the final step before approval and publication of any proposed or final rules. It is likely the home health proposed rule will be published by the Juneteenth or the July 4 holiday.