The final rule adds an estimated $390 million home health payment boost for agencies in 2021, or an aggregate increase of 1.9%. That estimate is less than the $540 million boost and 2.6% increase originally outlined in CMS’s proposed rule.
The increase reflects the effects of the 2% home health payment update percentage and a 0.1% decrease in payments due to reductions in the rural add-on percentages mandated by the Bipartisan Budget Act of 2018 for 2021, the agency noted. The rule also updates the home health wage index, limiting any decreases in a geographic area’s wage index value to no more than 5% next year.
On one hand, the rule brings a semblance of stability to the home health industry by not making any major changes to the Patient-Driven Groupings Model (PDGM). At the same time, by keeping the status quo, CMS also keeps in place the widely controversial behavioral adjustment built into PDGM.
Home health advocates had been pushing for CMS to reconsider PDGM’s behavioral adjustment for months, especially after an independent analysis found the overhaul lowered home health spending by a projected 21.6% in 2020. William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), expressed disappointment on that point in an email to the organization’s members.
“We are disappointed that CMS put off consideration of dropping the behavioral adjustment to payment rates based on its view that it needs a full year of data before it can act,” Dombi wrote. “We believe sufficient information is available to recognize that the behavioral changes assumed have not occurred. We will continue to work to get a mid-year rate change to reflect the absence of the rate behavior that CMS assumed.”
This is a developing story. Please check back shortly for additional updates.
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