Updated Plan: Ask Congress to STOP the Cuts in the Year End Package

From NAHC

Following the finalization of the home health rule NAHC engaged with the sponsoring offices of the Preserving Access to Home Health Act (S. 4605/H.R. 8581) on refining the legislation to better its chances for passage before the end of the year, as well as strengthen transparency of CMS in their rate-setting. Our champions on Capitol Hill are working to substitute this amended language in the negotiations for the year-end package. This amendment will not be introduced as new legislation.

While there won't be a new bill to call for congressional action on, you can still advocate for this revised approach.

Please contact our Senators and Representatives requesting they support a year-long delay (2023) of the home health rate cut and call for added transparency in CMS rate-setting practices. The NAHC Legislative Action Center is set up and ready with this message.

If you will be writing your own message or speaking with your elected officials here are helpful talking points:

The Issue

• The Centers for Medicare and Medicaid Services (CMS) issued a Final Rule on October 31, 2022, that reduces Medicare payments for home health services by $635 million in 2023 and triggers an estimated $18 billion in payment reductions over the next decade. Congressional action in 2018 required CMS to establish a new payment model that was "budget neutral," not one that cuts support for home health services by $18 billion.

• The impact of those payment cuts would exacerbate the ongoing dismantling of this essential benefit that serves over 3 million of the most vulnerable Medicare beneficiaries, providing them with exceptional quality care in their own homes, preventing high-cost hospitalizations, and offering an alternative to life-changing institutional care while saving Medicare billions in spending every year.

• Over the past decade, Medicare beneficiaries have experienced significant reductions in access to home health care that were not authorized or sanctioned by Congress.

• In the last 10 years, Medicare beneficiaries using home health services has dropped from 3.5 million beneficiaries annually to 3.1 million beneficiaries as a result of continually reduced payment rates. 

• With the $635 million payment cut in 2023, the permanent rate reduction of 7.85% finalized by CMS, and over $2 billion in planned "clawback" cuts, future care access can only worsen further in the face of $18 billion in current and future payment cuts.

• CMS has portrayed the recent action as an increase in Medicare spending on home health services, but that is highly misleading. The 2022 30-day national standardized payment rate is $2,031.64, yet CMS finalized the 2023 30-day national standardized payment rate at $2,010.69. This represents a reduction in year-over-year payment for care provided by home health agencies beginning in January, despite the significantly increased costs home health agencies continue to experience.

• CMS has refused to provide the data and information necessary to replicate its calculations and fully assess the validity of its methodology.

• Pending bipartisan legislation, the "Preserving Access to Home Health Act of 2022," S. 4605 and HR 8581, would suspend the behavioral adjustment rate cut to give Congress time to address the complex issues presented by the new payment model. A developing revision of this proposal would focus on suspending the payment cut for just 2023.

What Must be Done

1. Support stability in the home health care community in 2023 by suspending the entirety of the behavioral adjustment cut to the CY 2023 home health payment rate in CMS's CY 2023 Final Rule.

1. Strengthened disclosure, accountability, and transparency of the payment rate-setting method employed by CMS, including direct stakeholder engagement, to ensure a budget-neutral transition to the new payment system.

Encouraging Grassroots Outreach to Congress to Oppose Hospice Cap Cut

Now is the time to ask our congressional delegations to not make major cuts to the hospice aggregate cap in any end-of-year legislative package being negotiated. As is often the case with large, year-end spending bills, there are many programs and policies Congress wants to “stuff in” to an omnibus funding package before the close of the year. In order to pay for all these priorities, lawmakers must identify “offsets” to fund them. A significant reduction of the hospice aggregate cap, as has been recommended by MedPAC in the past, is being considered for one such “offset”.

The easiest thing you can do right now is to use NHPCO’s Hospice Action Network https://www.hospiceactionnetwork.org/take-action/#/ or NAHC's online grassroots campaign page https://p2a.co/mhu6Q52 to send our Senators and Representatives an email message and/or tweet asking them to oppose a cut.

It is always most impactful if you can personalize the pre-filled message language to talk about local impact. If you have good relationships with your members of congress' staff, please also consider reaching out to them directly to register your opposition.

HHAC is attaching a 2-pager background document that NHPCO and NAHC have prepared together. This document, and the talking points below, should help support any advocacy you may be able to engage in. Click here to access the 2-pager.  

• Patient access to care could be significantly reduced: a major cap cut would create disincentives to serve patients that have a more unpredictable disease trajectory, such as those with dementia and organ failure, thereby disenfranchising entire categories of patients’ access to the hospice benefit.

• It could further exacerbate health disparities in hospice access and utilization: The individuals most likely to have their access to hospice impacted by the cap reduction (those with dementia and other neurological diagnoses) are also more likely to be from medically underserved communities that already have lower rates of hospice utilization.

• It may result in increased overall spending by Medicare: Any proposal that could limit hospice use, such as the cap reduction, may result in increased overall spending for Medicare, as patients who might have been served by cost-saving hospice instead utilize more expensive and aggressive care such as hospital, ER, and skilled nursing facility services. Recent research has shown that hospice use by Medicare beneficiaries is associated with significantly lower total healthcare costs across all payers, including Medicare. 

Thanks so much for your help with this effort and for the work you are doing in the community. Please don't hesitate to reach out to HHAU with any questions.

ProPublica / New Yorker Magazine Article: How Hospice Became a For-Profit Hustle

As anticipated in last week’s newsletter, ProPublica and the New Yorker Magazine published an article on hospice care titled: “How Hospice Became a For-Profit Hustle”.

• Link to Article in ProPublica

• Link to Article in New Yorker

The almost 9,000 word article, which raises awareness about fraudulent activity under the Medicare hospice benefit, specifically cites alarming spikes in the number of newly certified agencies in CA, TX, NV and AZ. Unfortunately, the article also focuses on a nonprofit/for-profit division within the hospice community and brings attention to old court cases in a manner that could promote public distrust of hospice care.

There are bad actors in hospice, but they are small in number and need to be rooted out through state and national oversight bodies that have the tools to do it. In an effort to help bring attention to all the good being done by hospice, NHPCO has shared the attached talking points, which should help respond to any inquiries you may receive based on the New Yorker article.

Worker Shortages, Waiting List Inaccuracies Complicate HCBS Programs

McKnight’s Senior Living | By Kimberly Bonvissuto
 
The COVID-19 pandemic put a spotlight on fundamental, long-term challenges for state Medicaid home- and community-based services programs, but it also provided opportunities for change, according to a new Kaiser Family Foundation issue brief.
 
In 2021, states reported offering 255 waivers under Section 1915(c), the largest source of HCBS spending and the type through which assisted living operators often provide services, with an average of five waivers per state. The data are based on the 20th KFF survey of state Medicaid HCBS officials in all 50 states and Washington, DC, between April and September. 

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