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CALL for Action! Bipartisan lawmakers introduce legislation to ensure Medicare payment reductions are based on actual changes in provider behaviors.

February 18, 2019

Bipartisan lawmakers introduce legislation to ensure Medicare payment reductions are based on actual changes in provider behaviors.

Legislation such as the introduction of S. 433, to improve home health payment reforms hope to ensure beneficiary access to quality care services so that it is not compromised for America's growing senior population.

Introduced by Senators Susan Collins (R-ME), John Kennedy (R-LA), Bill Cassidy (R-LA), Rand Paul (R-KY), Debbie Stabenow (D-MI), Doug Jones (D-AL) and Jeanne Shaheen (D-NH), the legislation will refine home health payment to ensure behavioral-based payment adjustments are rooted in evidence and observed data.


CALL TO ACTION – Make your voice heard!

Contact Senator Richard Shelby asking for his support of S. 433

Phone- (202) 224-5744

(It's simple, just say, I would like to ask Senator Shelby to support S. 433, and then give your name and zip code.)

Or Email using the link below.


Contact Senator Doug Jones at the below to thank him for introducing S. 433.

Phone (202) 224-4124

Email at this link

The home health industry stands united in support of S. 433. This important legislation would:

1. Achieve full budget neutrality over the period of 2020-2029 

2. Prohibit any pre-change rate reductions based on assumptions 

3. Require behavioral adjustments based on real, actual changes in provider behavior that reflect provider behavioral changes in response to the new payment model rather than changes in the patient population. 

4. Permit a phase-in of rate adjustments (up or down) when an annual adjustment would be greater than 2 percent. However, the phase-in would operate to ensure full budget neutrality by 2029. 

5. Permit MA Plans and CMMI innovations to waive the "confined to the home" requirement under the Medicare home health services benefit when in the best interest of the Medicare beneficiary.

Finalized by Medicare last year, the Patient Driven Groupings Model (PDGM) is the most significant payment change to the home health system in 20 years.  If implemented as designed, PDGM will make payment adjustments based on behavioral assumptions as opposed to observed evidence or actual provider billing behaviors. The new payment structure could result in a $1 billion payment reduction in 2020. 

The bill (S. 433) would require Medicare to implement adjustments to reimbursement rates only after behavioral changes by home health agencies that affect Medicare spending occur instead of assuming changes might happen, ensuring a smoother transition to the new payment system. 

Alacare Home Health & Hospice thanks these bipartisan lawmakers in recognizing the vital role home health and hospice plays in our communities and looks forward to the passage of S. 433.

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