‘The Stability of Home Health Care Is at Risk’: CMS Proposes 4.2% Decrease to Provider Payments in 2023

The U.S. Facilities for Medicare & Medicaid Expert services (CMS) introduced its FY 2023 home health proposed payment rule late Friday.

It arrives with a reduce to payment prices by 4.2%, or $810 million significantly less compared to 2022 costs. In general, the proposed rule appears to be like to be one particular that will be disappointing to suppliers, and a single they will refute greatly in the public remark time period.

“This lower reflects the outcomes of the proposed 2.9% property wellness payment update proportion ($560 million enhance), an believed 6.9% lessen that displays the effects of the proposed potential, permanent behavioral assumption adjustment of -7.69% ($1.33 billion reduce), and an approximated .2% lower that reflects the consequences of a proposed update to the set-greenback decline ratio made use of in pinpointing outlier payments ($40 million decrease),” CMS wrote in its truth sheet.

The proposed rule validated fears that vendors have had since the hospice proposed rule and expert-nursing-facility proposed rules came out previously this year.

“We are incredibly unhappy in the CMS proposed rule issued nowadays,” William A. Dombi, the president of the National Association for Property Care & Hospice (NAHC), wrote in a comment shared with House Overall health Care News. “The steadiness of house well being care is at hazard as a consequence of CMS proposing the application a fatally flawed methodology for assessing whether or not the PDGM payment design led to funds neutral spending in 2020. That has been built distinct to CMS in the 2021 rulemaking and in various conversations due to the fact.”

They will very likely argue that the proposal evidently does not consider into account numerous components presently hindering suppliers, together with: elevated labor prices, a seriously significant inflation rate and other ongoing heightened charges relevant to COVID-19.

“With considerably rising charges for staff members, transportation, and more, property well being agencies across the place are unable to face up to the impact of the proposed price reduce,” Dombi included. “Reliable analyses proves that PDGM underpaid house wellness agencies. We will be having all methods to shield the residence wellness gain as this proposed rule advances and have thoroughly organized for Congressional action and far more. “

On the hospice facet, CMS recently proposed a 2.7% pay raise for 2023. In the meantime, SNF operators observed a proposed downward adjustment to SNF payment rates by 4.6%.

The latter price adjustment is partly to stability out the Patient-Pushed Payment Design (PDPM), which is related to the dwelling overall health marketplace, in that adjustments are being designed to the Individual-Driven Groupings Design (PDGM).

In that vein, CMS is proposing to use a long lasting possible payment adjustment to the dwelling wellness 30-day period payment fee. That would be to account for any improves or decreases in combination expenses as a result of the “difference involving assumed behavior improvements and real conduct adjustments,” due to the implementation of the PDGM and 30-day unit of payment.

The entire truth sheet from CMS can be considered listed here.

Household Wellbeing Treatment News will be covering the proposed rule all over the 7 days. Examine back every day for updates.