HHGM Rescue Bill

NAHC, Elevating Home, and the Partnership for Home Health offered what they are calling a “unified compromise proposal” to the House Ways and Means Committee in an effort to gain a withdrawal of the HHGM proposal from the CY2018 Home Health Prospective Payment System final rule.    The CMS Final rule is expected to be released within days – and there is no indication as to whether the hugely problematic HHGM will be modified or withdrawn.

Rather than be saddled with a rule the industry cannot sustain, the compromise proposal would take some of the pieces of HHGM (movement toward a 30- day payment with a new case mix adjustment process), but mitigate the financial impact by establishing in statute a 30-day payment rate and scrapping the CMS proposed case mix model to be replaced with one that would be developed in a fully transparent process by an industry technical expert panel.


Other provisions in the compromise are:

  • A 30-day unadjusted payment rate of $1772 (which would be about a 3% cut, vs. a 15% cut in the HHGM proposal)
  • Expansion of the current VBP to all 50 states
  • Extension of the 3% rural add-on to 2023
  • Nurse Practitioners being allowed to sign plans of care
  • Some mitigating language around face to face documentation and a settlement process for face to face claims still stuck in ALJ review

This proposal would need some complex and long shot legislative maneuvering to make it through both Houses of Congress – ideally BEFORE the CMS rule comes out.    This proposal clearly has some down sides, but the intent is to reduce the pain of the HHGM proposal.

There is no action required of the Board at this time.   The legislation is complicated and moving fast.  I am not going to alert the entire membership at this time, as there are too many moving parts.  I will send out a Legislative Bulleting early next week once I have a better sense of the where things are.

Update: It appears that the Office of Management and Budget got the message from Senators regarding the HHGM.  They have asked for the calls to stop.  This was conveyed to me by both NAHC and Senator Shaheen’s office.

So there is no need for you to contact Senator Shaheen’s or Hassan’s Office at this time.

Here is a link to an op-ed on HHGM that appeared in The Hill, which is widely read by lawmakers and staff in DC.  http://thehill.com/opinion/healthcare/356945-untested-proposals-will-cut-medicare-and-hurt-seniors