CMS issues CY 2024 proposed rule to reduce home health net payments by US$375M; proposed PDGM behavioral adjustments could lower payments by an additional US$870M, despite concern from AHA

The Centers for Medicare & Medicaid Services June 30 issued its calendar year 2024 proposed rule for the home health prospective payment system, which would reduce net home health payments by an estimated $375 million, or -2.2%, in calendar year 2024, relative to the year prior. CMS is proposing a 3.0% market basket update, reduced by a 0.3% productivity adjustment. 
 
However, the agency also proposes to apply the full permanent behavioral adjustment due to the implementation of the Patient-driven Groupings Model of -5.1% in CY 2024, which would reduce total payments by an aggregate $870 million. In addition, the agency also proposes an estimated 0.2% increase in payments for high-cost outlier cases. AHA has previously expressed concern about the scale of the proposed PDGM behavioral offsets, and is disappointed CMS continues to seek their implementation.
 
For the home health quality reporting program, CMS proposes to adopt two new measures for the CY 2025 program, including a measure on the percentage of patients who are up to date with their COVID-19 vaccinations. The agency also proposes several changes to the measures used in the Home Health Value-based Purchasing program and, accordingly, the weighting methodology used to score performance and payment adjustments in the program. 

CMS will accept comments on the proposed rule through Aug. 29. AHA members next week will receive a Special Bulletin with additional details on the rule.