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Home health providers raise alarm over proposed payment changes

WASHINGTON — Advocates say a new rule could result in cuts in payments to agencies in Vermont that provide health services in patients’ homes.

The Centers for Medicare and Medicaid Services proposed a rule that would change how payments are made to home health service agencies under Medicare.

The proposal includes shortening the period of care — from 60 days to 30 — that is used as the basis for Medicare payments to service providers.

The change would result in a $950 million reduction nationwide in Medicare payments for home health services in 2019, according to estimates.

Jill Mazza Olson, executive director of VNAs of Vermont, said Vermont home services providers are bracing for a cut in funding, but she was unable to predict how much.

The Vermont association and many others around the country are urging the federal government not to proceed with the rule.

Forty-nine senators from both parties signed a letter last month inquiring about the change and requesting that CMS work with stakeholders before moving forward.

Sens. Patrick Leahy, D-Vt., and Bernie Sanders, I-Vt., signed the letter.

Olson said the Vermont home health agencies are open to changing how Medicare payments work but believe the current CMS proposal has not been thoroughly vetted and tested.

“We’re in favor of payment reform, and we don’t oppose the idea of relooking at how we’re paid,” Olson said. “But this (model) is untested and not budget-neutral.”

Olson said she fears the change in how Medicare payments are made could hinder broader health care improvement efforts the state is undertaking.

“What we’re really trying to do in health care reform is really focus more on the health of all Vermonters, and that often means really meeting (people) literally where they are in their homes,” she said.

A spokesperson for CMS said last week that the agency is reviewing public comments on the rule.

Olson did not have a clear idea of what the proposed change to Medicare payments might mean for home health services funding in Vermont.

The state’s model of home health services is highly regulated and different from other parts of the country, where the system is driven by competition. As a result, the state’s home health agencies could be affected differently from those in other states, she said.

“Their view on home health is not very reflective of what home health looks like in Vermont,” Olson said.





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