S.433: Home Health Payment Innovation Act of 2019

The Home Health Payment Innovation Act (S.443) would preserve Medicare beneficiaries’ access to existing home health services. This bill includes two key components. First, it waives homebound rules for services provided to individuals enrolled in Medicare shared savings programs and beneficiaries enrolled in Medicare Advantage. This legislation would also modify the Medicare PDGM by requiring the Secretary of Health and Human Services to implement payment modifications based only on experience and data generated after PDGM is applied rather than assumptions that could occur under the new PDGM structure. Additionally, this bill would provide for the phase-in of any necessary rate changes to be no higher than two percent per year to limit the risk of unnecessary and harmful disruptions in care.

Home health care is a critical service that allows more than 3.5 million patients to be treated in a preferred and cost-effective setting. It has been estimated that CMS’s Patient-Driven Groupings Model (PDGM), scheduled for implementation on January 1, 2020, could result in a 6.42% payment reduction in the first year alone, equaling an estimated $1 billion. While we support increasing efficiencies in Medicare, it must be done in a way that does not negatively affect access to care for the rising number of seniors who depend on these services to remain healthy and at home in their communities.

H.R. 2573 is the House companion bill introduced by Rep. Terri Sewell.