The home health community has voiced support for the potential rate increase in the proposed home health payment rule for calendar year 2027, while noting a few caveats. Providers and advocates are now filing comments as the window for public comments draws to a close.
Commenters broadly praised the proposed rule change, while also urging the Centers for Medicare & Medicaid Services (CMS) to appreciate the true costs of home-based care, to provide clearer safeguards for legitimate home health during fraud enforcement actions and to ensure the rule does not restrict access to home-based care for medically complex patients.
On July 1, CMS proposed a rule that would increase home health aggregate payments by 2.4%, including a 2.1% payment update and 0.3% increase for the Fixed Dollar Loss ratio. The total proposed pay increase would rise to $420 million for home health services, a marking a departure from the payment cuts included in the last several years of rulemaking.
The public comment period will close at the end of the day on Aug. 31 to submit comments. Over 250 comments have been submitted as of the time of this story’s publication. Home Health Care News featured standout statements from five letters to CMS.
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Cornerstone VNA strongly supports CMS’ exploration of a home health-specific wage index and urges the agency to develop a methodology that reflects the actual cost of delivering home health services in community-based settings. The current hospital-based wage index fails to capture the economic realities facing home health agencies and, for Cornerstone VNA, suppresses reimbursement in our highest volume service area at a time when costs are rising at three to five times the rate of reimbursement increases.
— Jennifer Ufkin, president and CEO, Cornerstone VNA
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Axxess supports CMS’s objectives. Our principal recommendation is that CMS increasingly treat interoperable, auditable healthcare technology as infrastructure for achieving those objectives.
[…] Axxess encourages CMS to consider not only whether a requirement is substantively appropriate, but also whether the requirement can be operationalized through modern digital systems without imposing unnecessary administrative burden on clinicians.
One of the most significant ‘downdraft’ effects providers expect over the next several years will be the expansion of a data-driven regulatory enforcement. Federal regulators increasingly use sophisticated data analysis tools to identify providers they believe may present compliance or fraud risk. This includes predictive analytics, billing trend reviews, ownership tracking and comparisons of utilization patterns between agencies. As a result, organizations with inconsistent operational practices, incomplete clinical documentation, unusual visit utilization patterns or weak oversight processes may attract regulatory attention even when there is no intentional fraud involved.
— John Olajide, founder and CEO of Axxess
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While we recognize that the 2.4% proposed payment adjustment is, when compared to previous years, a positive development, it nonetheless does not fully keep pace with current labor and operating cost pressures, which are keenly felt by providers after years of payment cuts. Compounding this fact is the CMS’s proposal to both continue with temporary recoupments and to maintain the permanent behavioral adjustments based on Calendar Year (CY) 2020-22 data. We’ve long maintained that the latter warrant a reexamination, and we continue to do so. Our comment letter will outline the specific methodological factors deserving greater focus.
In addition to that, we will also address the proposed rule’s significant expansion of CMS’s enrollment denial, revocation, reporting and related enforcement authorities for all Medicare providers, along with the simultaneous removal of or omission of objective standards and procedural safeguards. The result could be severe and far-reaching enrollment consequences for legitimate providers based on technical errors, the conduct of third parties and staff outside their control, or broadly defined associations rather than intentional or egregious misconduct.
Targeted program integrity measures are the answer, not a blanket approach. We will urge the agency not to finalize this rule as proposed.
— Katie Smith Sloan, president and CEO, LeadingAge
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I write on behalf of co-op.care, a worker- and family-owned home care cooperative based in Boulder, Colorado. We are an early-stage, pre-revenue organization building home care in which the caregivers who deliver the care are worker-owners, and in which every visit is verified three ways: that it happened, who delivered it, and — the part usually left out — whether it actually helped the person. We are not a large agency, and we do not write to defend a payment line. We write because this rule asks two questions at once, and we think there is a single answer to both.
The rule tries to expand access and protect integrity at the same time. The proposed rule seeks comment on promoting community-based palliative care through the existing home health benefit, and simultaneously proposes far-reaching program-integrity measures — expanded enrollment revocation and denial authority, retroactive revocations — alongside a temporary behavioral adjustment to recoup prior overpayments. These goals ordinarily pull against each other: broadening access invites the fraud that integrity measures then restrict, and blunt integrity measures deter honest providers along with dishonest ones.
— Blaine Warkentine, founder, co-op.care
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The beneficiaries at the center of the dementia dyad are clinically complex, socially complex, and dependent on a family caregiver — and a substantial share are dually eligible for Medicare and Medicaid, reflecting their intensive long-term services and supports needs. This rule can make home-based, caregiver-inclusive care more accessible for them, or it can quietly price it out. We urge CMS to make caregiver training and caregiver-burden assessment explicit, covered skilled care in the palliative BPM examples, including a dementia-specific example; ensure any new wage index reflects the full home-based workforce; protect access for ADRD and dual-eligible episodes as the temporary adjustment and LUPA thresholds take effect; build caregiver-facing, function-focused, dual-stratified quality measurement into the HH QRP and HHVBP alignment; and apply the new geographic-density revocation authority with safeguards so it targets fraud clusters rather than legitimate community-based providers serving high-need dual-eligible markets.
— Genevieve Caruncho-Simpson, co-founder and CEO, Dyad Health