Home care stakeholders break down ‘uncertain’ legislative and regulatory landscapes

With more attention than ever on home care, there are a number of legislative and regulatory developments that will be essential for providers to stay informed.

For providers like Help at Home, which works in the Medicaid space on private pay, the short-term gains are obvious.

“If you take what’s been going on this year and last year and put it in a bubble, I’d say funding and repayment has been encouraging,” said Deb Oberman, senior vice president of government relations at Help at Home, during a panel discussion last month at HHCN’s Capital+Strategy conference. “If you take that bubble away and think about what we all expected to be a precursor to Build Back Better, it was all shaping up pretty well.”

That said, Oberman stressed that the future was still uncertain.

“There was a great recognition of the importance of home care and home and community supports, and we saw sources of funding like we really had never seen before,” she said. “We were also seeing recognition, both at the federal and state levels, that you need consistent and sustainable funding streams for the long term. I would say that in the short term it is encouraging and in the right direction, but in the long term there is still a question mark.

Vistria Group Supported Home Help is one of the largest home care organizations in the United States. The company has more than 170 branches in 11 states. It recently entered New York with two major acquisitions.

At Help at Home, 90% of the company’s funding comes from state government Medicaid programs.

On the other hand, reviewing the landscape of Medicare reimbursement for home care providers, William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), believes that the Centers for Medicare & Medicaid Services (CMS) will likely look at budget neutrality for moving to the Patient Centered Cluster Model (PDGM).

“It has been ignored for the past two years, the data was not yet available on it,” he said during the roundtable. “The methodology they suggested to use has sent everyone’s alarm bells ringing – a 6% reduction for 2020 would be here. We believe this is a fatally flawed methodology. We are preparing for a battle with CMS on this, if they pursue this methodology, we foresee the potential for serious WWIII type combat with them.

Dombi noted that CMS is likely to owe home health agencies, rather than Medicare program providers, due to increased wound care service delivery and reduced therapy services.

Another upcoming change in home health is the nationwide expansion of the home health value-based purchasing model (HHVBP), but Dombi believes this will likely be “business as usual” for providers.

“Home health care agencies have long focused on the quality of care outcomes because they had to compete, whether on star ratings or home health care comparisons,” he said. . “Now dollars are involved in it. When we looked at what happened in the nine states with the demo program, it really wasn’t disruptive. It triggered improvements across all vendors, basically increasing performance was a good thing there.

However, Dombi expressed concern about how the expansion of HHVBP puts providers in direct competition with organizations in other states.

Regarding legislative updates, Oberman expressed optimism that a version of Build Back Better will be in the future.

“The term Build Back Better – we don’t hear that anymore,” she said. “But through the partnership for Medicaid-Home Based Care, and others, we’ve had a number of recent virtual meetings on the Hill. I think if it was completely dead in the water, people would be calling in two months. It would be, ‘I’ll talk to you in a moment.’ They invite us and roll up their sleeves.

That said, Oberman doubts that Build Back Better is the exact same package as before.

Looking ahead, John Olajide, President and CEO of Axxess, believes it is imperative that suppliers proactively engage in policy, regulatory and reimbursement discussions.

“I always tell people that when you don’t have a seat at the table, you’re on the menu,” he said during the roundtable. “As an industry, we are always reacting to a lot of these changes and it shouldn’t be just reactionary. We want to make sure that we engage more actively, at the political level with CMS. Let’s discuss what needs to happen and get some datasets so we can make those arguments. »

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