The 2025 Home Health (HH) PPS Proposed Rule has recently been published in the Federal Register:

• Link to the June 26 Public Inspection Desk presentation – you can request a ‘bookmarked’ version of this for a nominal fee (the bookmarks assist w/the review process)
• Link to the July 3 Federal Register presentation

Executive Summary – summarized

The proposed changes combined are expected to reduce CY 2025 home health spending by approximately $280 million (a 1.7% reduction to HH Spending).

Note: This reduction is to HH Spending!  This IS NOT what individual HHAs should expect the impact to their 2025 Medicare revenues/payments will be.

• • Some will realize a reduction to their Medicare payments of approx. 1.7%; but most will not!
  • Some will actually realize an increase in their Medicare payment rates,
  • Others will realize a decrease in their Medicare payment rates, but less than the -1.7% noted for HH Spending,
  • While others (likely, most) HHAs will realize a decrease to their Medicare payment rates greater than the -1.7% noted in the Proposed Rule

. . .  Note: The projected impact to your agency can be accurately estimated.  Please contact me if you are interested in obtaining this analysis . . . 

The projected $280 million reduction to HH Spending is made up of the following ‘big-picture‘ changes:

• the Market-Basket (inflationary) update: a 2.5% increase in HH Spending (+ $415 million),
• the Permanent Behavioral Assumption adjustment: a 3.6% decrease to HH Spending (- $595 million), and
• the Updated Fixed-Dollar Loss (FDL): increase the FDL to decrease HH Spending by 0.6% (- $100 million)

Home Health PPS

Numerous changes to HH PPS, including to:

• The CY 2025 payment rates for HHAs
• the payment rates for disposable negative pressure wound therapy device
• the 432 PPS/PDGM Case-Mix Weights (CMWs)
• the LUPA thresholds
• reassignment of specific ICD-10-CM Codes under PDGM
• the scoring for the functional impairment levels and the comorbidity adjustments
• County-CBSA changes, some counties, changing from:
  • Urban to Rural (almost always a reduction to the Wage-Index & reimbursement for these counties)
  • Rural to Urban
  • from one Urban Area (CBSA) to another Urban Area (CBSA)
• Wage Index changes
• the LUPA add-on factors
• increase the Fixed-Dollar Loss (FDL) for Outlier payments ($100 million decrease to HH Spending)
• once again, apply a Permanent Behavior Assumption Adjustment (a $595 million decrease to HH Spending for CY 2025!)

Additional Changes

Other areas in which CMS is proposing changes includes:

• Home Health Quality Reporting Program (HH QRP)
• the Expanded HH Value-Based Performance Model (VBPM) {remember, financial impacts begin 1/01/25}
• Medicare Home Intravenous Immune Globulin (IVIG) Items and Services
• HH CoP Changes and Long Term (LTC) Requirements for Acute Respiratory Illness Reporting, and
• Provider Enrollment – Provisional Period of Enhanced Oversight

Conclusion

As always, there is a lot going on in this year’s Proposed Rule; with several areas being unusual (e.g., counties changing service areas/CBSAs) and/or controversial (e.g., the Permanent Behavioral Assumption Adjustment).  These two areas, along with many others are worthy of a more intensive review by the industry and for comments to be submitted to CMS to support the industry’s position regarding these proposed changes.  Commenting on these proposed changes is part of the Rule-Making Process that has always been available to us, but for far too long, far too few in our industry have participated in this opportunity thru which we can positively impact our future.

Keep in mind the Supreme Court’s recent reversal of the Chevron Doctrine which gave non-elected bureaucrats significant leeway in interpreting congressional legislation.  The overturning of that doctrine should greatly limit a bureaucratic agency’s ability to make non-congressionally mandated changes; especially those of a significant nature.

Idea for a Potential Comment to the 2025 HH PPS Proposed Rule:

Citing the recent Supreme Court reversal of the Chevron Doctrine along with Congress’ explicit instructions that the change to PDGM (in CY2020) should be budget neutral, should be a strong position that CMS’ creation and use of the Behavioral Assumption Adjustments since 2020 should be reversed and credited back to the industry and eliminated from further consideration going forward.

There’s the foundation of a comment that you could send in as an interested party.  I would just request that you re-word the above to make the terminology unique to yourself so that if 1,000s would use this suggestion, there would be 1,000s of different ways in which this concept was put into words for CMS to consider.

There are numerous ways for comments to be submitted, which are identified in the first few pages of the Proposed Rule.  However, IMHO, the easiest is electronically:

• just go to https://www,regulations.gov (be sure to cite: CMS-1803-P)
• Verify that you are at the CY 2025 HH PPS Proposed Rule comment area (or go to Comment)
• and submit your comment(s)

You can submit your comment(s) as an individual, on behalf of an organization, or anonymously.

If you work in the home health industry, this should be looked at as voting should be looked at for a US citizen – something that we all should do; or don’t complain about the outcome!