Name: 2027 Home Health Proposed Rule Key Changes, Big Implications
Uploaded: 2026-07-21T22:03:46.217Z
Duration: 36 min 26 s
Description: 2027 Home Health Proposed Rule Key Changes, Big Implications

Transcript for "2027 Home Health Proposed Rule Key Changes, Big Implications": Hello, everyone. Thank you very much for joining our webinar on the 2027 home health proposed rule. We're certainly just gonna, hit the key highlights for the leaders. I'm not gonna read every every word and every paragraph to you, certainly. Very pleased to, be joined today by Lanchy, Bombalier, from ROL, Golden, and Gregory and, Arlene Maxim, our vice president of clinical service senior vice president of clinical services here at Access. Launching is a partner at, Arnold, Golden and Gregory, and, certainly, both these ladies are very well versed versed in, home health compliance and regulation and, our wealth of knowledge. My name is Mike Carr. I'm a the senior director of training education here at Access, and I'll be serving kind of as the the moderator, throughout our our conversation today. So the good news, I I think, is that the the proposed rule is less intimidating and scary than what it has been in recent years. So we'll we'll let the the ladies dig into the details. There's certainly, some some meat on the bone, certainly, of things that we need to be aware of and, prepared for. But just in general, it feels more favorable than than what we've been, beaten down on in, in recent years. So, the proposal is to have a a 2.4% aggregate increase in Medicare home health payment, compared to the current year, compared to fiscal year twenty twenty six. Industry wide, that would be an increase of $420,000,000. Probably, some of that good news is what was not news, and they're not proposing, additional permanent PDGM behavioral adjustment for 2027. They certainly are gonna continue with the temporary adjustments, being factored in and that that's included in that overall 2.4% increase. So, it's complicated math and none of us are CPAs, so we're not gonna dig too deeply into to those numbers. But, the important piece is that, it's a it's a slight move, probably doesn't keep up with inflation, but slight move in a in a positive direction. It does include, enhanced program integrity and enrollment requirements, which are aimed at reducing fraud, waste, and abuse, which we certainly, are all in agreement that, there's no place for that in our our precious industry. There are limited changes, to the home health quality reporting, which is, again, a a nice change not to have to relearn a new new system nor are there any significant changes to home health value based purchasing. So, again, no, no need to spend time, trying to learn new acronyms or new changes, on that front. And interesting that, the the rule recognizes and expresses interest, in expanding and refining palliative care access. So, again, more to come on that, I think, as as we provide feedback, as an industry to to CMS and just kind of what their where their minds are headed with that. But, again, that feels like very positive news for for us and for the for, certainly, for patients and families. So, again, we arrive at that 2.4%, net payment, increase, through, again, the convoluted math of a a 3.1% market basket update, productivity adjustment, which is in the negative range, and then a 3% positive change for the outlier payments and fixed dollar loss, variable, which comes up to the 2.4% net increase, which, again, if we calculate that off throughout the entire industry, is $420,000,000, in a in a positive direction for a change. So, again, probably, could always be better news, but at least it's not, not as as angst producing as it has been some years. So, again, not to not to get into the the deep math, but, the the permanent behavioral adjustment, is something that's been in place for the past several years and against reaction to what CMS, feels like the industry has been credited for overpayment because of the behavioral adjustments we we took with PDGM. They've they've stopped that, for this year, which, just in comparison, is a is more than a 1% change in a in a positive direction for us than what it was last year. Because last year, the final rule included a negative one over 1% permanent payment adjustment. So some of the favorable the no news, I I think, is what we're trying to say there is that they're they're not doing that, for this year, and hopefully, that's the trend that stays in place. There's no, no permanent payment adjustment going forward as well. But I think that kinda tees us up kinda situationally, Lanji, for your thoughts about kinda where we were with the overpayments and where we are now and maybe, looking in your crystal ball to see where CMS may be looking at, home health as an industry going forward. Right. Thanks, Mike. And, yeah, you're right. The the math this year on the payment was very, favorable compared to past years. But I think that the number from a legal and compliance standpoint that that always catches my eye is regardless of whether you agree with their methodology or not, they are still estimating that there was 4.9, billion dollars in overpayments, to home health providers. And I think that sets the backdrop for maybe some of the other, proposals and announcements in the rule this year where it looks like based on that concept that home health is still subject to significant overpayments, that they are setting up now, what I would consider, like, a web of enforcement tools that when connected or combined together, kind of create, perhaps, a backdrop for catching fraud and abuse, certainly. But, also, it will certainly, a lot of good providers and and folks who are doing the right thing are probably gonna get caught up in, some of the enforcement activity. And so that's where, when I look at the other proposals, and the rule related to revocations and looking at enrollment, disclosures related to relationships, that's where I see a lot of the the legal and compliance aspects that that providers probably wanna take a closer look at and get familiar with. Beautiful. Thank you. Anything to add to that, Arlene? No. But I I I guess one of the things that I would say about this is that, the government never gives us anything without taking something back. And, I think that Launchee's very right in in saying that this oversight that we're going to see within the next few years is probably something we've never encountered in the past, and that compliance has got to be king. And, I mean, I would have compliance written all over my walls if I owned a home care agency because I think that over the next year or two, we're gonna see some incredible, audits. I think that surveyors are probably going to get more involved in the, the even the financial part of it, perhaps, maybe, notifying, the contractors if they if they haven't already been doing that. But, notifying them if they see any evidence of any kind of fraud and abuse. But, we just can't forget what we've been seeing over the last few months on television. Every time you turn the TV on, you see something about that. So the government's not gonna give us anything without making sure that they're getting their fair share back. Excellent. Yeah. You you mentioned compliance, and I think there's compliance or poor compliance versus fraud are very different things. And I I think that we all agree that, you know, a lot of what we can guard against, we can't prevent fraud. There's gonna be bad actors out there that are doing this for the wrong reasons, and we all universally wanna get rid of them. But what we do need to guard against is people who are being unintentionally noncompliant because they don't understand. So I think education is is a big part of what everyone needs to, embrace and and learning from experts like you guys and, and, you know, attending webinars like you're all doing today. I I think that that's a a very positive step, and I think that's what we need as an industry is to understand better so we can comply better. Correct. So speaking of, compliance and fraud prevention, again, the the rule does point out some things that Lanxi, alluded to, with regarding, you know, revocations and being retroactive, allowing CMS to recover payments made during those periods of noncompliance, expanding the grounds for denying or or revoking provider enrollment, and so on. I know you all can read, so I won't read the slide to you. But, again, why don't we, start the ball rolling with you, Arlene, just to kinda get some of your thoughts about what you saw in the proposed rule about both compliance and fraud prevention? Well, what as far as, revocations, being retroactive, that's really interesting because they they it's somewhat vague to me in the final rule, and I don't know if launching has any, additional information about this. But in the final rule, it doesn't really, detail, what types of things are gonna be considered noncompliant. I can see where if there were significant, survey issues, that of noncompliance, if the, the agency was found outside of compliance on a conditional level, where the safety would maybe an immediate jeopardy issue, that could also be considered, something that they would, revoke a, provider number for. So I think that we're gonna have. To we'll learn more, of course, in the final rule, and I'll be interested in listening to other folks' ideas on how what they mean by by this. Again, compliance, making sure everyone understands the rules. Obviously, what we've seen on TV and on videos, we're seeing evidence of folks who just didn't wanna follow the rules. And like Mike said, we wanna keep the compliant agencies available to patients. We don't want patients without being without care. But there are going to always probably be actors out there that try to circumvent, what's going on. One of the things that isn't specifically mentioned but is concerning to me is we have a number of, organizations who do what when they when they're switching ownership, during the thirty six month rule where they have to hang on to the ownership for at least thirty six months, they enter into what they call management agreements. And so a new owner may come in and not take over the ownership, ownership specifically, but they will offer to manage and offer a management contract. Now those management contracts, from what I know, from of the the number of organizations that I work with and I know, they do not submit an eight fifty five a, which they need to be doing. They haven't talked about that specifically in the final rule, but I have a hunch that that's going to be enforced and, not only enforceable, but enforced in the future. So, I I do think that that's an issue that we need to be concerned about. And I do and I also think that part of, this rule, with the the, ownership, the majority ownership issue that's in there, I do think that they probably will try to enter into more management agreement. So, well, I think there'll be, it'll be interesting over the next period of months to see how, everyone reacts to it and how CMS reacts to it. It's always interesting. That's for sure. So, thank you, Arlene. Any kind of, points that you'd like to make, Conchie? Yeah. And I think, you know, when I when I look at the rule, I always look at the new risk areas, and I think Arlene pointed out a couple of them. Right? The revocation, certainly, the, the proposed language, certainly would expand, the discretion that CMS has in initiating revocations, under the the current provisions. So the current provisions, they have a lot of different bases for which they could, they could initiate a revocation action. It removes some for, like, abusive billing privileges. You know, that would be one that I I would say in the past, we've seen them use that, probably quite aggressively in the past couple years. And one of the bases that we always had for fighting those was because, there are certain enumerated factors that CMS has to consider if they're gonna undertake a revocation due to abusive billing privileges, and the proposed rule would take those factors away. Not so much, no longer, you know, would you be able to support, appeal based on the fact that they didn't look at the factors. It takes those away and it gives CMS even broader protection. And I think, what Arlene, referred to with regard to the retroactive application, which is the the other risk area, is in many instances, there were certain areas of revocation where the action would be prospective. Right? So providers would still have some entitlement to claims that were billed, or would be also allowed to continue billing claims until the prospective date of enrollment. Now they're suggesting that all revocation actions should be retroactive, which means to the extent that a provider has billed, certainly, that time period between, the the the billing that they performed and then the retroactive revocation date, there certainly would be an overpayment there where I think CMS would then certainly go after them to repay monies that they had billed, based on the initiation of a retroactive, revocation date. So certainly a lot of dollars on the table. I think certain actions would have that would have been perspective, in the past would now become retroactive. And I think, I think the number that I saw was they thought maybe it would result in $82,000,000 of overpayments being returned to the the Medicare trust fund, and then that would probably be, you know, the impetus that they have for returning, for adding that language and and making these revocations retroactive as opposed to perspective. But certainly, a big burden, right, on those providers that when they're hit by revocation action. No. Absolutely. Excellent. Well, thank you, Mike. I think the other thing that we neither one of us touched on here is there that last point you have here, Mike, where it talks about the ability to take action when owners and managers are affiliated with organizations that have integrity issues. So that what that's saying to me is that if you have someone who has been a DME provider and have had issues and thought, well, I'm gonna jump to, health or I'm gonna jump to hospice, that's gonna be, that's gonna be an issue that they're gonna undertake, and they're going to probably not allow that. I think that they're gonna be well, I'm hoping and because I think that's one of the problems we've had. I'm hoping that they're going to be, really looking at those eight fifty five a's and the applications, much more carefully now and do some cross referencing. I know a lot of folks who are in home health a number of years ago that, ran into problems with either medical reviews or some type of integrity problems, and switched to, lab services, for instance, or switched to DME, or switch to hospice. They they got into trouble one place and they went over somewhere else. Well, CMS already knew they were in trouble in the one place. So they're going to the second place. It now it the way else it is now has been no one's questioned it. Now that's going to change, I believe, and I believe that there's gonna be a lot more scrutiny with the eight fifty five a. And so I think that, you know, one of the things I wanna make sure that everybody understands before we leave here today is that eight fifty five a needs to be completed, and they're going to be watching that much more carefully to make sure that, and they've identified the number of peep the types of folks that need to be included on that eight fifty five a in the proposed rule. And we don't have that included that list included here. But if anyone is interested, I'm happy to email that to them or they can find it in the proposed rule. But I think that's a really important point that that eight fifty five a is not something to fill out once and be done with it. That needs to be kept up to date and and with the right people. So, Arlene, I think, I know we're talking to home health providers today, but I definitely think a lot of them probably can benefit from talking to some of their partners when that when those, eight fifty five a requirements were rolled out to the skilled nursing, facility industry, right, where they're trying to get more information about private equity companies and health care real estate entities, in addition to the the whole, expansion that they've proposed about looking at affiliated parties and relationships. I think what we're we're seeing here is, something that providers can prepare for because as as far as what I read into the rule is that they really weren't just the, rollout of the eight fifty five a disclosure requirements was much more of an announcement rather than a proposal related to notice and comments. So there's I think it's coming. I don't I I do think that providers know how they can prepare because we've seen the skilled nursing facility industry go through that. But it is a lot of information, and it's having to capture a lot of information on parties that may not be used to Medicare and enrollment disclosures in the past and making sure that that stays organized and updated. And, you know, in addition to rolling out what was previously already, required in terms of, discussing, you know, managing employees, and certain relationships. I think they're also suggesting or proposing to expand those definitions to include even more folks. Right? The affiliated party, language where it discusses, you know, financial any marketing business, fulfillment, financial, and managerial or beneficiary relationship that could potentially be covered right now. I think there are probably gonna be a lot of questions all over the industry on what who exactly is captured within that disclosure. And there's also no five year look back that they're proposing. They're proposing to remove that, so it could be an affiliation that has existed, right, for a long time that then now providers are gonna be tasked with, collecting that information and disclosing that information as part of the eight fifty five a process. And I think that's definitely something that providers could start getting their arms around now and maybe reaching out to some of their connections and other industries to see how they've they've managed it. Certainly, certainly, I think it's something that's coming down the Turnpike because it doesn't seem to be a proposal. It's more or less an announcement there. Yep. I agree. Yeah. Thank you, ladies. And another big topic, in the proposed rule is is palliative care. And, again, I think this raised a lot of eyebrows when they first saw it and a lot of hopes, and and maybe those hopes will come come true. But at this point, it's really as the way I, interpreted the the final rule, which, is probably subject to debate. But that the the signal of of future policy interest rather than any imminent, you know, reimbursement or operational changes, you know, as of when this rule goes into place. The proposed rule will become a final rule at some point. But but it really felt like CMS was really looking for feedback on how palliative care is currently being delivered by home health agencies and barriers and opportunities to treat those people who are with serious illness who may benefit, but who aren't ready, who aren't eligible, or aren't willing to, accept hospice care. But I also thought it was important to note that the rule does not do anything day one, including establishing a new, Medicare palliative care benefit or creating a separate reimbursement for palliative care or or change hospice eligibility or require agencies to provide off, palliative care. So, that that was my take. But, again, we'll we'll start with, with you, Elantje, I think, to see what your your thoughts were and kinda where you think this is teeing things up for and what maybe you would suggest agencies to do if they're interested in diet and care in the future. Right. And I I think your instincts are spot on, Mike. I definitely think that this was definitely an indication of, like, an a policy directive, right, or a suggestion to providers about how palliative care could fit within a home health benefit, but certainly no expansion of the benefit, from a payment perspective or anything else. But but more of, I think trying to connect the dots for providers to the extent that they are considering palliative care. I think we know that palliative care exists out there already in many different models and and, in different forms from a from a provider level. And I think this is just CMS's, kind of, like, thought process about how it could fit within, the Medicare home health benefit. I think the important thing to note that they that they highlighted is that even to the extent that palliative care services might fit it within the service line of a home health agency, any providers wanting to provide palliative care would still have to meet, the the home health eligibility requirements, which would require, obviously, that the the beneficiary is homebound, and that they need skilled services, which could be a differentiator, from, you know, other palliative care programs, but certainly different criteria that would have to be met for for those palliative care patients that a that a home health agency would wanna take care of. Excellent. And I know this is something you've given a lot of thought and, exploration into. Arlene, what are your what are your thoughts about value to care being proposed? Yeah. Thank you, Mike. Well, first of all, I just wanna point out that CMS has been doing demonstration projects on this since 2012, and, they've gotten a lot of data. Back in, just recently, 2016 to 2021, they actually did a demonstration project with a 141 hospices. Now I don't know of any any demonstration projects that have been done with home health. And it's interesting to me that they have assigned this now even though most of the demonstration projects were with hospices, they've assigned it to home health. I believe that this may be a bridge to something bigger and better. I'm hoping that it is because as Lonji mentioned, these patients have to be homebound. Most patients with serious illnesses is one of the things they have is depression. In hospice, there's no homebound statute. The hospice patient can go out, just because they these patients are what I I'm considering palliative care like a bridge to hospice. I don't understand why they would need the homebound requirement, but that's the way it's going to be for now. They do point out that this can't be advertised. So, you know, a couple years ago, there was a lot of information. I can't remember the rule right now. I'm launching, maybe you do, that came out about how we have to keep our website up to date and our brochures and that type of thing. We can't advertise this is a new program. This is a new vet not a new program, a new benefit. However, you know, home care agencies for years have had wound care programs where they've hired inner normal therapists, they've hired specialists in that area. And so, putting together a palliative program within the home care company, is not a bad idea. And, I it's not you can't say it's a new benefit because like see, they're pointing out in this proposed rule is that they have to require the skilled care. So all the eligibility requirements have to be there. It's just going to be one more added thing. And they did say that they would be changing the benefit policy manual and probably give them some examples of where this would fit in. But I I do think that we're gonna have to be careful and make sure that, there's a link between the home care agency that's using palliative care and the hospice. And I I'm wondering if the the surveyors in particular are going to question agent home care companies as to who they who they're going to refer once that patient reaches the level of hospice through the palliative care program and, where they're gonna refer them. Now many many home care programs have a hospice, and that's great. That's gonna be an easy transition for them. But recognizing the signs, understanding, I think there's gonna be a whole new training level that, I'm sure that, access training certification will pick up and have have a session on this. But I do think that it's going to be something that, we have to get used to. Can advertise it as a new benefit because what CMS is saying, it's not a new benefit. It's been there all along, and we should have been using it. But many organizations have palliative programs within their hospice organization, so it'll be interesting to see how that that switch is gonna take place. That's for me. Yeah. And I'll I'll just add that I I think when CMS is putting the idea out there, and I I I love this, because I do think that innovation stems from ideas and and policymakers and providers getting together. But But I think there are gonna be a lot of issues to untangle. As you mentioned, Arlene, there are a lot of hospice providers in the space. There are a lot of physician groups in this space already. And then you have to think about the interplay of state level laws, licensure. You know, certainly, certificate of need is an issue in many states for home health and for hospice. And then the the concept of, you know, which suite of services are are you gonna include in your palliative pro care program, and and is that supported both by the payment policies of CMS as well as as your state level licensure, requirements and the scope that you're allowed to cover under licensure state licensure. So lots of interest you have to dig into if we think about how you And policies and procedures too. Everyone's gonna have to update their if they're going to include those, update policies and procedures. And one of the things I want to, make mention of is just yesterday, their the final rule for the physician fee schedule came out, and they're also asking them for an RFI. They asked hospice for an RFI back in June or, I mean, the comment period was the end of June. So, hopefully, everybody, sent comments in. I'm encouraging every single person, that listens to this to make sure they write comments. Comments do make a difference, and CMS does read the comment. They do read the comments. So, make sure that you're writing comments, whether an individual, if you're a patient if the if you're having patients do it, you're or, making sure that your state association, I'm sure most of them or all of them will do that. But the comments are really, really, really important. So it'll be interesting to see when they get RFIs from, home care hospice and the physician group, where this is gonna land. So next year, I expect to see, more detail than this, and maybe they'll change their mind about things. But I just, again, one once again, I just think it's so interesting that all of the demonstration projects that I'm aware of, have been in hospice, and they have not done one in home care. So, it's just very interesting to me that they've included it here. Thank you, Arlene. Thank you both. And appreciate you mentioning the comment period, and, I think this is as good a time as any to and, Lonshi, when we were chatting before we got started, mentioned the word advocacy. This is certainly a proposed rule. So, this is our opportunity to let CMS know what we think on each side of the coin, things we like and and want them to to stick to their guns with and things that we think they can do better on. So, please don't hesitate to to, submit your thoughts and and work with your peers to submit their thoughts as well. I think that's we owe that to the industry, to try to continue to make it better. It's it's served us all well, so we need to continue to to, foster it. So, I intentionally left this slide, kind of vague, so we can kinda go whatever direction you you ladies would like to. But, important to note that our email addresses are on here if if any of you have questions or need a little more, interaction or or feedback from from, either of our experts or somehow anything I can do to help you, we're all certainly, happy to. But, let's let's start with you, Launcey. Just anything that we didn't cover or this kinda crossed your mind in the last few minutes that you think the agency should kinda gear up for and, be ready to to attack or if this proposed whatever form you do think that, in terms of the ramifications, I I think that, CMS definitely needs to hear comments from the industry related to how that's gonna impact providers. I think, certainly, the broader discretion is not necessarily a good thing. The retroactivity is not a good thing. Their expansion and I I don't think we brought this up. It's a lot of ours, but they they also have a reapplication bar that they want to make, applicable regardless of the revocation action, not just for fraudulent information to ten years. So, certainly, I could see a worst case scenario where a a provider maybe has some sort of ministerial or typographical error as part of their enrollment application. They get a revocation action because that's the lead that CMS is building. Right? And then, they get revoked, and then they have a reapplication bar for ten years. Those those are all worst case scenarios, but I think those are the things that, providers really need to to think about, in terms of trying to explain why that's, you know, gonna be a very, I guess, broad brush to paint the to paint the industry with when you have, some bad actors that you need to take care of. Right? Just providing a lot of discretion to to CMS with their enforcement tools. Great. Thank you. And how about you, Arlene? Anything that you think you'd advise agents that you want? Yeah. I'm always interested in giving people tips for success. So, one other thing, of course, as I'm already mentioned that, getting that comment pure getting a comments in during the comment period, which ends, I believe, it's August 30 or thirty first. Is that correct, Launcee? I think that's the right time. I think it's August 31. Yeah. And then make sure that you start now. I as as we mentioned, we need to change policies. You're going to if you're going to, do palliative care, you're going to need policies. Make sure you your coders are familiar with what types of diagnoses go along. It doesn't have to be a terminal diagnosis for palliative, but make sure that your coding is correct, when creating your plan of care. Your compliance program. I you know, like I said, compliance is king. Make sure you've got a strong, strong compliance program and educate. You can't do compliance without educating your staff. So your staff have to be educated, particularly in this program, is how you're going if you're going to do this as a program, as something addition that you haven't done in the past, make sure your staff are educated on this because it it's complex. And we we wanna make sure that we're not hanging on to these people for research after research, that we are transitioning them into hospice when the need is there and that they're willing to accept hospice. And make sure that, you know what your data is as far as PDGM, if if this is causing lupus for you. There are ways to all of the disciplines are included. We're in home health. We've got everything included. What was interesting to me in reading, the, proposed rule, they talk about palliative care requiring spiritual intervention. Well, the in home health, we don't have chaplains. So, could your social worker do some of that? Perhaps. But palliative should include spiritual, so you might wanna think about that and how that's going to work. And then the last thing would be just to make sure that you have technology that is updated, and that supports compliance throughout, using dashboards, analytics, and that type of thing. I think those five key things with the number one being get your comments in and number two being compliance is king is, going to be the thing that's going to make a big difference in the way your, if your organization is successful or not in this new information. Great. Final word launch here. Anything else? Very soft, but a lot of good stuff too. So it's always a nice balance, to think about for the proposed rule. And I'm definitely looking forward to seeing what gets finalized. Excellent. Well, thank you very much. I think that's gonna wrap us up for today, but thank you, both ladies for, sharing your time and expertise with us. And, again, thank you all for joining us. And if you have any, questions or comments, please reach out to to any of any of us, and we'll be happy to get back in touch with you. Have a great day. Thanks, Mike. Thanks. Thank you for joining Access On Demand. Visit access.com for more on demand videos, industry resources, blogs, and answers to frequently asked questions. Access, empowering care anytime, anywhere.