One of the nation’s largest nursing home industry groups is cautiously backing part of a plan to boost home health system’s coffers by $250 million.
“We support efforts to modernize and improve the home health benefit,” said LeadingAge’s Aaron Tripp, Vice President, Reimbursement and Financing Policy. “Both the revision of payment to emphasize clinical factors and more closely tie payment to beneficiary needs (i.e., the Patient-Driven Groupings Model), as well as the proposal to allow health paraprofessionals to perform at their highest level of training should help to achieve that goal.”
The Centers for Medicare & Medicaid Services made several recommendations in its proposed rule along with the 1.3% increase. These included a new permanent home infusion therapy benefit that will let patients have the option of receiving treatment such as chemotherapy at home. CMS also proposed updates under the Patient-Driven Groupings Model and recommended therapist assistants be allowed to perform maintenance therapy at home.
More controversially, CMS has recommended phasing out Request for Anticipated Payments. Home health providers can receive up to 60% of anticipated payment at the beginning of a patient’s care through RAP, which regulators have warned leads to fraud schemes.
The phase-out worried LeadingAge, Tripp said.
“The combined negative financial impact due to an increased reliance on unobserved, prospective behavior assumptions, the proposal to eliminate RAP payments, and the ongoing phase-out of the rural add-on payments will trouble many of our members, who as nonprofit organizations, operate on slim margins,” Tripp said. “Because of the current trend of shifting beneficiaries out of institutional settings for acute and post-acute care, we would like to see CMS supporting home health agencies through this transition to the PDGM, as opposed to punishing the entire field due to practices of bad actors in the past.”