Final Rule ‘Blunts Immediate Impact,’ But CMS-Home Health Industry Core Disagreement Remains

Home Health Care News | By Joyce Famakinwa
Nearly five months after the unveiling of the proposed payment rule caused a stir among home health stakeholders and advocates, the U.S. Centers for Medicare & Medicaid Services (CMS) released its final payment rule on Monday.
Back in June, CMS proposed a 4.2% aggregate decrease for 2023, a cut the industry at large felt would be devastating.
Though CMS will still usher in other cuts and permanent adjustments related to the rebalancing of the Patient-Driven Groupings Model (PDGM), the final rule comes with an increase in the aggregate by 0.7%, or $125 million compared to 2022.
While many in the industry acknowledge that CMS has made efforts to address the concerns of providers, most are still stressing that the methodologies CMS is following will eventually crush providers and access to care .
“CMS has rightly recognized the challenging operating environment providers are currently navigating and reduced payment cuts from the 7.69% proposed in June to the 4% announced today,” LeadingAge President and CEO Katie Smith Sloan, president and CEO said in a statement. “That, along with the 4% market basket update that addresses rising costs of providing services, indicate CMS is cognizant of current realities. We appreciate that — but at the same time, we remain concerned.”
CMS also decided to take a phased-in approach to the behavioral adjustment and only impose about a 3.5% adjustment for a 30-day period. This is an overall $635 million decrease in reimbursement for agencies.
“Agencies need to understand that this is only ½ of what will be imposed after this year,” J’non Griffin, senior vice principal of coding and the OASIS department at SimiTree, told Home Health Care News in an email. “The remaining permanent adjustment, along with any other potential adjustments needed to the base payment rate to account for behavior change based on data analysis, which are all required by law, will be proposed in future rulemaking.”
In the wake of the proposed payment rules release, many took aim at the behavioral adjustment methodology CMS used. With the final rule out, it is still viewed as problematic.

[The HH PPS Final Rule is available at]

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