CMS recently finalized calendar year 2019 and 2020 payment changes for home health agencies. The new payment model, also known as the Patient Driven Groupings Model (PDGM), was finalized on October 31, 2018. There is some good news: We will see Medicare payments increase by 2.2%–or $420 million–based on finalized policies this year. The reimbursement rate increase is the first the home health industry has received in a decade. Unfortunately, the final rule addresses that home health will see a decrease of payments by 6.42% based on the use of “behavioral assumptions” which will take effect January 2020.

Luckily Congress is working with the industry and has introduced corrective legislation into the House and Senate that counteracts this measure. Several of our legislative champions, including Vern Buchanan (R-FL), sponsored one of the three bills introduced, each of which would serve to counteract the “behavioral assumptions” by requiring Medicare to implement adjustments to reimbursement rates only after improper behavioral actions by home health agencies are actually observed affecting Medicate spending rather than assuming those improper activities will occur. While this is a great first step, we need more legislative support to ensure that one of these bills crosses the finish line.

How can you help? The Government Affairs Office (GAO) has been working diligently to meet with key legislators and introduce them to our issues and those of our staff and clients, but we can’t do it alone. BAYADA has been asked to take the lead of home visits for our industry and we need office staff to help us communicate the importance of home care and proper Medicare reimbursement for our services.

To join in our advocacy efforts, please consider meeting with your federal Congressman or Senator through an office visit or home visit. Contact GAO Federal Associate Lindsey Wright today to learn more and to coordinate. The Federal Affairs team has a busy first month of the year and will be making visits to Home Health offices the year to hear what is most important in your office and how we can help.

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