stethoscope money

A coalition of home healthcare leaders called on the Centers for Medicare and Medicaid Services Thursday to rescind the 4.36% behavioral assumption cut next year as part of the Patient-Driven Groupings Model payment rule.

In a letter to CMS about the 2022 Home Health Prospective Payment System, the Partnership for Quality Home Healthcare said the reduction is based on “flawed assumptions, data and methodology.” The organization said the decrease could cost home healthcare agencies approximately $2.3 billion between 2020 and 2022, resulting in financial harm to providers that could undercut patient care.

PQHH claims the behavioral adjustment that went into effect last year was based on the assumption that home healthcare providers would upcode and increase the number of patient visits under PDGM. But the coalition said independent analysis of CMS data found that never occurred and that Medicare payments to agencies actually were 5.6% lower last year.

PQHH Executive Director Joanne Cunningham told McKnights Home Care Daily the coalition has been having quarterly meetings with CMS for over a year and remains hopeful CMS will rescind the rule.

Joanne Cunningham

“We’ve always had excellent audiences with CMS,” Cunningham said. “We can’t predict what they will do in the final rule, but the data is compelling and there is no sort of other side of the data.”

PQHH is not alone in its effort to get CMS to rescind the behavioral adjustment. The National Association for Home Care & Hospice has also been critical of the rule.

CMS announced proposed HHPPS rules for 2022 at the end of June. Medicare payments to home health agencies would increase 1.7% next year, compared to a 1.9% increase agencies received this year. CMS is expected to make a final ruling on HHPPS in the next couple of months.