As previously discussed, the Home Health industry is currently facing a behavioral adjustment to their rates. This adjustment stems from the change in the home health payment system to PDGM from PPS.  The omnibus bill passed toward the end of last year, mandated CMS to hold meetings and provide precise calculation data for determining the behavioral adjustment with which the Home Health industry does not agree.  

On March 29, a webinar was held that attempted to answer questions related to calculating the behavioral adjustment. However, the webinar fell short in providing sufficient detail and had major flaws in what is considered an acceptable calculation for this adjustment.  

The therapy allocation is still being used for calculation purposes, which is a part of the Prospective Payment System that paid more for additional therapy visits. However, this is no longer the case under the PDGM model. Despite this, a portion of the old calculation is being used to determine the behavioral adjustment under PDGM, which is irrational. 

During our recent trip to Washington, DC for the March on Washington sponsored by the National Association for Home Care and Hospice, we were able to meet with representatives and request their assistance in sending a letter to CMS. The letter would specifically call for CMS to refrain from making additional payment adjustments until a resolution is reached between the industry and CMS on how to calculate the behavioral adjustment.  

We need your help in contacting your congressional representatives to request that they send letters to CMS, urging them not to impose further rate cuts on Home Health until the current situation is resolved. The cost of care has increased significantly and is not currently considered in these calculations. It is imperative that CMS realizes this and incorporates the inflated costs we are currently experiencing when making these decisions to help ensure the continuity of Home Health agency care.  

To make a significant difference in stopping the feared rate cuts in the upcoming Proposed Rule for 2024, it’s crucial for you to become involved. Click here for examples and resources available to help write letters to your representatives on this matter, and it’s essential to stay informed through your state and national associations. Whether it’s through calls, emails, or letters, your intervention can play a crucial role in preventing these rate cuts from becoming a reality.  

If Healthcare Provider Solutions can ever assist you in any way, please don’t hesitate to reach out.   

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