The Medicaid Entry Rule has been finalized, with six years till implementation of the 80-20 provision. Nonetheless, there isn’t a time to relaxation for house care suppliers and regulatory advocates. Summer time is close to, and meaning so is the Facilities for Medicare & Medicaid Providers' (CMS) proposed fee rule for house well being care.

In 2022, a big proposed minimize to house care largely caught suppliers unexpectedly. It was anticipated in 2023. And sadly, the house care business expects extra of the identical within the subsequent proposal.

The counterbalance to CMS' price cuts and clawback makes an attempt stays the identical in 2024, and is all-encompassing: motion by native suppliers; a lawsuit towards CMS and the U.S. Division of Well being and Human Providers (HHS); a push for congressional assist and direct pleas to CMS to rethink its methodologies.

In 2024, plenty of main developments have already taken place on these fronts.

For instance, in late April, the Nationwide Affiliation for Residence Care & Hospice's (NAHC) lawsuit towards CMS – first filed final July – was dismissed by a federal choose. Though it was an unlucky replace to the state of affairs, NAHC President William A. Dombi acknowledged that the authorized battle was removed from over.

“We’re disenchanted with the court docket's ruling,” Dombi stated. “Nonetheless, it’s a small setback that we are able to simply overcome. Typically justice is delayed whereas justice is denied. That is the place we are going to spend our day in court docket. This struggle is way from over.”

In the meantime, Sens. Debbie Stabenow (D-Mich.) and Susan Collins (R-Maine) despatched a letter final week to CMS Administrator Chiquita Brooks-LaSure strongly arguing towards additional cuts to house well being care funds.

“We respect CMS's dedication to serving to individuals get the care they want, the place they want it,” the senators wrote. “This could embody house well being care providers for individuals with Medicare. As CMS continues to develop the 2025 Medicare house care charges, we encourage you to think about the worth that house care supplies to the Medicare program and its beneficiaries.”

There's rather a lot happening in Washington, DC this yr. Suppliers and advocates should discover a approach to minimize by the noise to get the eye of lawmakers who can stop additional cuts.

This week's members-only HHCN+ Replace focuses on house care fee insurance policies for the following 5 months, and what the business expects is clear.

Extra cuts in prospect

There may be not a supplier I’ve spoken to this yr who expects something aside from additional cuts in June or early July. That's as a result of CMS made clear in final yr's last rule that there was extra to come back on the leading edge.

Joanne Cunningham, CEO of Partnership for High quality Residence Healthcare (PQHH), as soon as once more predicted a “bleak, bleak” coverage panorama for house well being care by 2024 in January.

However Cunningham additionally believes that 2024 as an election yr works to the business's benefit.

“We all know that in an election yr, Congress may be very keenly attuned to the wants of its constituents,” she advised me. “We’re very hopeful. We’re working with a few of our advocates in Congress to seek out options that may make their method right into a package deal that Congress will undoubtedly suggest that addresses Medicare advantages. Our purpose is to ensure that house well being is a part of that.”

Beforehand, lawmakers launched the Preserving Entry to Residence Well being Act. Comparable payments have been launched in 2022 and 2023, in each the Senate and the Home of Representatives. The newest model would have softened the cuts and in addition pressured the Medicare Fee Advisory Fee (MedPAC) to take a extra holistic view of house well being reimbursement by together with Medicare Benefit (MA) funds.

After two years of cuts – a 2.890% minimize final yr and a 3.925% minimize the yr earlier than – suppliers would doubtless get a reprieve, however a reprieve isn’t the purpose.

CMS has proposed extra extreme cuts than it has just lately accomplished, which may end in a barely optimistic general fee adjustment. However these optimistic changes are solely superficially optimistic, and that's a narrative PQHH, NAHC and the supplier neighborhood try to inform.

Based on PQHH, CMS has applied or introduced greater than $19 billion in cuts since 2020 by 2029. Because the chart above reveals, these cuts can have a compounding impact over time.

Lately, CMS has dismissed well being care suppliers' considerations about entry to care and has not wavered in its technique.

“After I work with individuals at CMS, I discover that I'm typically very impressed with sensible people who find themselves attempting to do good work,” Michael Johnson, president of house care and hospice at Bayada, advised me final yr. “I at all times attempt to ensure I don't vilify these individuals as a result of I believe they're actually attempting to do an excellent job. However crucial instrument they’ve is fee. All they’ve is a hammer. So when it is advisable to alter a screw, you continue to use a hammer, and we all know what the outcomes of that appear like.

Chargebacks

Suppliers face that hammer, and the result’s the graph above.

However CMS can also be in search of to get well “overpayments” it made to suppliers in 2020-2022: $873 million in 2020, $1.2 billion in 2021 and $1.4 billion in 2022.

At this level, yearly that the house well being care business doesn’t absolutely win the battle towards CMS, the potential impression of cuts and clawbacks for years to come back turns into larger and larger.

VitalCaring President Luke James and I had a dialog about these recoveries on stage final month at Residence Well being Care Information' Capital + Technique convention.

“I don't wish to beat a useless horse, however this momentary fee adjustment, the longer it sticks and isn't applied, it's solely going to get larger by way of magnitude,” James stated. 'I do know we've been speaking about it for 3 years. And I believe perhaps we've turn out to be somewhat numb to that. However the numbers are very giant and so they seem to be issues; they solely worsen as they fester.”

I then requested whether or not James would like to see these clawback cuts applied now.

“I would like in the event that they weren’t applied in any respect,” he continued. “I'd fairly they see the failed logic they're utilizing. … But when they're going to implement them, I believe I'd fairly take a rip-off method. As a result of it's a scarcity of certainty that creates a really troublesome marketplace for deal making. Certainty – fairly than perpetual uncertainty – is a greater place for my part.”

At this level within the recreation, morale is definitely a part of the equation, virtually as a lot because the nuts and bolts concerning fight cuts. Suppliers have been preventing tooth and nail to outlive and advocate for greater than two years now.

Stabenow and Collins' letter to CMS is additional proof of the bipartisan assist the business has in Washington, D.C.

But when 2024 isn't the yr issues flip round for the higher for house care suppliers, will probably be troublesome to persuade smaller suppliers that the struggle remains to be price preventing – once more.