The U.S. Centers for Medicare & Medicaid Services (CMS) released its FY 2023 home health final payment rule late Monday.
It comes with an estimated increase to 2023 home health payments of 0.7%, or $125 million, compared to 2022 aggregate payments. Overall, the final rule is much better news for providers than what was previously expected.
The agency had initially floated a 4.2% aggregate decrease in 2023, which would have marked one of the steepest home health Medicare cuts in years. While that’s a positive development, CMS is still phasing in smaller cuts and permanent adjustments related to the rebalancing of the Patient-Driven Groupings Model (PDGM).
At least for now, PDGM clawbacks appear to be delayed.
“CMS is phasing-in the permanent adjustment by finalizing a -3.925% permanent adjustment for CY 2023,” the agency wrote in its fact sheet. “The -3.925% permanent adjustment is half of the full permanent adjustment of -7.85% (-7.69% in the proposed rule). This rule also discusses the comments received on the best approach to implement the statutorily required temporary payment adjustment for CYs 2020 and 2021, and those comments will be considered for future rulemaking.”
Strong pushback from providers across the country, as well as numerous home health advocacy organizations, seems to have paid off.
For context, 51% of agencies were in danger of going in the red had CMS’ proposed payment adjustments been finalized, according to a summer analysis from the National Association for Home Care & Hospice (NAHC).
While it still may not be considered a great outcome, it’s far better than what providers considered the worst possible outcome over.
In addition to the payment rates, CMS is finalizing a methodology to “determine the impact of differences of assumed and actual behavior changes on aggregate expenditures, as well as a permanent prospective payment adjustment to the home health 30-day period payment rate to account for any increases or decreases in aggregate expenditures.”
The full fact sheet from CMS can be read here.
This is a developing story. Please check back later for additional updates.
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