On July 28, 2017, CMS published the calendar year (CY) 2018 Home Health Prospective Payment System (PPS) Proposed Rule (the Proposed Rule) in which it proposed a new CY 2019 Home Health Groupings Model (HHGM). The proposed HHGM is set to take effect January 1, 2019. It will replace the current 60-day episode of care payment model with a 30-day period model. The new model will place patients into 144 payment groups based more heavily on clinical characteristics and other patient information rather than the number of therapy visits. Comments were already due to CMS by September 25, but within the last couple of weeks, bipartisan Congressional opposition to the HHGM has been mounting.  

In a September 22 letter to CMS, Senator Orrin Hatch (R-Utah) requested that CMS not finalize the HHGM in its forthcoming final rule. He argued that more time and “robust data analysis” is needed because the HHGM in the Proposed Rule differs from MedPAC’s recommended options. Hatch also argued that CMS exceeded its authority by proposing regulatory payment reform in a non-budget neutral or partially-budget neutral manner. The Proposed Rule cites that the HHGM would save $950 million in CY 2019 if implemented in a non-budget neutral manner and $480 million if implemented in a partially-budget neutral manner.   According to Hatch’s letter, CMS may propose budget neutral changes, but changes that generate mandatory savings which are returned to the Treasury must be directed by Congress. Finally, Hatch argues that CMS has not provided sufficient data or assumptions behind these numbers that would enable stakeholders to independently evaluate the agency’s data and conclusions within the 60-day comment period.

Following Hatch’s letter, a bipartisan group of 49 senators signed a letter to CMS and the then-Secretary of HHS Tom Price, dated September 26, 2017, also requesting that CMS not finalize the HHGM in the final rule “until affected stakeholders can fully analyze and understand the impact of the proposed changes.”  In the letter, the senators specifically ask whether CMS plans to provide the data used to produce the cost estimates of the HHGM. If so, the senators ask when the information will be available, and if not, the senators request the rationale for not providing the information.