Fixing PDGM

Despite opposition from the home health industry, CMS included a “behavioral assumption” reduction in its final proposal to move to a Patient-Driven Groupings Model in 2020. The reduction is expected to decrease Medicare home health payments by over a $1 billion. Several bills have been introduced in Congress to stop the behavioral assumption and require CMS to wait for any actual provider changes after PDGM is implemented. The best chance for passage is to embed these bills in a comprehensive bill during the lame duck Congressional session. We’ll keep you posted!