The Situation Report | December 18, 2023
Last week, the Medicare Payment Advisory Commission (MedPAC) held their annual December public meeting to discuss payment rate adequacy across the Medicare program. For the Home Health session MedPAC staff provided a detailed presentation to the MedPAC Commissioners on the current state of the Medicare home health benefit, which resulted in a recommendation by staff to reduce the Medicare CHHA base rate by 7 percent in 2024.
The following are notable data points provided by MedPAC staff from Medicare home health 2022 data:
- Medicare margins nationally for 2022 was 23 percent, down from 24.9 percent in 2021.
- All-payer margin nationally in 2022 was 7.9 percent, down from 11.9 percent in 2021.
- Medicare program spent $16.1 billion on home health care, down from $16.9 billion in 2021.
- There are over 11,300 certified home health agencies (CHHAs) nationally, down from 11,400 in 2021.
- 2.8 million beneficiaries received CHHA services in 2022, down from 3 million in 2021.
- CHHAs had 8.6 million 30-day periods of care in 2022, down from 9.3 million in 2021.
- 98 percent of beneficiaries live in a ZIP code served by two or more CHHAs.
- In-person visits averaged 8.6 per 30-day period, down from 8.8 in 2021 and 10.6 in 2019.
According to MedPAC staff, quality of care remains satisfactory for Medicare fee-for-service (FFS) home health beneficiaries. Although the beneficiary discharge to community rate declined slightly in 2022, the overall rate remains high at 74.7 percent. Additionally, patient experience measures remained steady in 2022.
MedPAC continues to rely on the number of agencies within a zip code as a proxy for adequate beneficiary access to home health services even though the metric has been challenged by researchers and our colleagues at the National Association of Home Care and Hospice (NAHC).
Unfortunately, none of the MedPAC Commissioners challenged the report data or disagreed with recommendation to cut the base rate by seven percent. HCA and NAHC have challenged the accuracy of the data presented particularly with regards to Medicare and overall payment margin data does not include Institutional or Hospital-Based CHHAs that have traditionally had very low or more likely negative profit margins.
HCA also continues advocating Members of the NY Congressional Delegation to cosponsor the Preserving Access to Home Health Act of 2023 (PAHHA), introduced in both the House (H.R. 5159) and Senate (S. 2137) that would prevent the recent cuts by CMS from taking effect. HCA continues to urge all members to access our Legislative Action Center here to send your direct appeals to Delegation members to co-sponsor PAHHA to protect home care from these devastating cuts.
HCA will continue to update the membership on any future MedPAC meetings and activities.