CMS scrubs plan for home health groupings model
- The Centers for Medicare & Medicaid Services has decided not to continue with plans for the value-based Home Health Groupings Model (HHGM), according to a final rule released Wednesday.
- Under the scrapped plan, Medicare payments for home health would have been based on clinical characteristics and patient information rather than treatment episodes, and increased payments for medically complex patients.
- The agency said it needs more time to consider stakeholder concerns about the proposed model before moving forward on home health payment reform.
Providers praised the CMS’ decision to not finalize HHGM, saying it would allow time to develop a more patient-centered approach.
In comments on the proposed rule, the Center for Medicare Advocacy argued the proposal — which would have lumped payments into 30-day increments that declined with time — favors patients who recover quickly. “The HHGM will ensure little or no access for people who are clinically complex and have chronic illnesses and impairments,” the group wrote.
The Home Health Prospective Payment System final rule for 2018 also includes an $80 million cut for home health providers, down 0.4% from 2017. Much of that is due to the Affordable Care Act, which required CMS to compensate for overpayments for home-based services. For each year since 2014, the agency has reduced the 60-day payment rate by $80.95.
In January, CMS issued a long-awaited final rule updating home health agency requirements for Medicare and Medicaid participation. The focus is intended to be more patient-centered, data-driven and outcomes-oriented than the previous framework.
As the population ages, opportunities to improve health while reducing costs will be increasingly important. A CMS pilot program to bring primary care services into patient’s homes saved $7.8 million, or about $746 per beneficiary, in its second year. For home health programs to succeed, however, CMS needs to ensure broad access to services and adequate payment.