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PMHC HCBS Funding Alert

From Partnership for Medicaid Home-Based Care (PMHC)

Senate Majority Leader Chuck Schumer (D-NY) and Sen. Joe Manchin (D-WV) announced an agreement on a reconciliation package that includes tax and energy provisions in addition to drug pricing reforms and additional ACA subsidies.  As currently written, The legislation – the Inflation Reduction Act of 2022 – does not include funding for Medicaid HCBS. This is a narrowly crafted compromise approach and other things were also dropped.

Senate Democrats who have championed permanent Medicaid HCBS funding indicated to PMHC as recently as this week that the parameters of a reconciliation bill would be determined by Leader Schumer and Sen. Manchin.  It is unlikely that the Inflation Reduction Act of 2022 will be modified to include HCBS funding.  However, PMHC weighed in with Leader Schumer’s policy director in support of including Medicaid HCBS investments in the reconciliation bill.  We encourage PMHC members to use the VoterVoice grassroots campaign to urge Members of Congress to support these critical investments. 

The legislative text and summaries of the Inflation Reduction Act are available here.  The bill is expected to be considered by the Senate next week. 


CMS Announces Unprecedented Quality Measure Set for Home- and Community-Based Services

Home Health Care News / By Andrew Donlan

The Centers for Medicare & Medicaid Services (CMS) released its first ever home- and community-based services (HCBS) quality measures Thursday.

The agency said the measures will promote “consistent quality measurement within and across state Medicaid HCBS programs” and are a “critical step to promoting health equity among the millions of older adults and people with disabilities who need LTSS.”

The measures are built around three pillars: access, a rebalancing of HCBS spend versus institutional care spend and community integration. For now, the measures are voluntary – with one caveat. 

“While use of this measure set is voluntary at this time, CMS plans to incorporate use of the measure set into the reporting requirements for specific authorities and programs, including the Money Follows the Person (MFP) program and future section 1115 demonstrations that include HCBS,” a state Medicaid director letter read.

The MFP program is a CMS-directed way to get individuals out of institutional-based care and back into their homes and communities to receive HCBS. As recently as March, CMS put forward $110 million to boost MFP, and therefore HCBS services, across the country.

In other words, following the measure set is strongly encouraged for states.

“CMS is using every lever available to protect and expand coverage for all people eligible for Medicaid,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “We are working to expand their access to care across settings – including in the setting of their choice.”

While the home health industry is highly – and very consistently – regulated across the country, the personal home care industry has not been historically.

Strictly private-pay providers will still not be affected necessarily by the CMS quality measure set, but it is a sizable step to industry standardization, particularly among Medicaid-focused, HCBS providers.

“Today’s announcement provides states with tools to better understand and compare health outcomes across groups receiving home- and community-based services,” Brooks-LaSure continued. “The use of consistent quality measures across the country is another step toward reducing health disparities and ensuring that people with disabilities, and older adults enrolled in Medicaid, have access to and receive high-quality services in the community.”

The measures are aiming to obtain the aforementioned three goals:

  • Increased access, defined as beneficiary and caregiver awareness of resources that support overall well being and HCBS.
  • A rebalancing, which is aimed at finding a more equitable balance between spending on institutional care and HCBS care in communities
  • Community integration, which is focused on “ensuring the self-determination, independence, empowerment and full inclusion” of children, adults and older adults in the Medicaid program receiving HCBS 

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CMS Seeks Public Feedback to Improve Medicare Advantage

Today, the Centers for Medicare & Medicaid Services (CMS) released a Request for Information seeking public comment on the Medicare Advantage program. CMS is asking for input on ways to achieve the agency’s vision so that all parts of Medicare are working towards a future where people with Medicare receive more equitable, high quality, and person-centered care that is affordable and sustainable.

“Medicare Advantage is a critical part of CMS’ vision to advance health equity; expand access to affordable coverage and care; drive high quality, person-centered care; and promote affordability and sustainability of Medicare,” said CMS Administrator Chiquita Brooks-LaSure. “Medicare Advantage plans are essential partners in this work.”

“We see a huge opportunity for partnership with as many stakeholders as possible to better understand how care innovations are changing outcomes and costs and how Medicare Advantage is working for enrollees,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare. “It’s important that CMS engage as many stakeholders as possible to achieve our collective vision of equity, access, quality and affordability.”

The CMS Strategic Pillars prioritize increased engagement with the agency’s partners and the communities we serve throughout the policy development and implementation process. CMS is committed to creating additional opportunities to engage the public and drive innovation in ways that best serve people with Medicare.

In the Medicare Advantage program – also known as Medicare Part C – Medicare contracts with private insurers that must offer all Traditional Medicare services to people with Medicare and may offer added supplemental benefits, such as vision or dental benefits. Most Medicare Advantage Plans also include prescription drug coverage (Part D).

CMS encourages the public to submit comments to the Request for Information. Feedback from plans, providers, beneficiary advocates, states, employers and unions, and other partners to this Request for Information will help inform the Medicare Advantage policy development and implementation process.

The Request for Information can be accessed from the Federal Register at:


Home Health Providers, Staff in For ‘Rude Awakening’ Following Public Health Emergency Expiration

Though it sometimes may not feel like it, the expiration of the public health emergency (PHE) will, one day, come.

And when it does, that will have ramifications on home health providers specifically, and home-based care more generally. With the declaration came a handful of waivers and flexibilities meant to alleviate the harsh impacts of the pandemic for home health providers.

The Biden Administration extended the PHE for another three months on Friday, but providers will need to prepare for the day it will eventually come to an end. 

The PHE was originally declared in March of 2020, retroactive to Jan. 27, 2020. This past April, the U.S. Department of Health & Human Services (HHS) extended the emergency status for 90 additional days, to July 15.

Concerns around waivers and flexibilities

Along with the PHE declaration came a number of regulatory waivers and flexibilities meant to streamline health care processes and ease the overall burden of the pandemic for providers.

One of these waivers made it possible for any of the disciplines — nursing, physical therapy (PT), occupational therapy (OT), or speech language pathologists — to conduct home health admissions based on the needs of the patient.

If the PHE ends, this waiver is not expected to become permanent, according to Cindy Krafft, the co-owner and co-founder of the consulting firm Kornetti & Krafft Health Care Solutions.

“It has deeper regulatory issues and stuff that would have to be dealt with, but it is still allowable in the waiver situation,” she told Home Health Care News. “The reason I think it’s going to be a challenge is the current staffing situation in home health. We know that several agencies are at crisis levels and the ability to move admissions to therapy and take some of that off of nursing, when appropriate, has become routine.”...

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APTA Advocacy Network Legislative Action Alert

After holding off on any big changes to home health payment in 2022, CMS plans to take some major steps in 2023 to address what it describes as the gaps between "assumed behavior changes and actual behavior changes" resulting from the Patient-Driven Groupings Model payment system implemented in 2020. Translation: The PDGM has cost significantly more than CMS hoped, so to reach its goal of budget neutrality compared with the previous system, the agency has proposed changes that would reduce payment by 4.2%, or about $810 million compared with 2022 amounts. 

The bulk of the cuts is directed at the 30-day payment rate, but even if those reductions are put into place in 2023, CMS believes more changes will need to be made in the future to recoup the payment differences that have already occurred under the PDGM — an estimated $2 billion gap so far. To that end, the proposed rule also seeks public comment on how to best make up the difference.

We need you to submit a comment to CMS on this issue. APTA is preparing comments on the rule to submit by the Aug. 16, 2022, deadline but we need your voice and your stories sent to CMS as well. Please use this template to send your comment and be sure to customize it with a personal story. Adding a personal story is important because it ensures it will be individually reviewed by CMS.

The deadline to submit comments is August 16, so we need you to act now and encourage others to send a comment of their own.

Thank you for your advocacy and making a difference on behalf of the physical therapy profession and the patients we serve.

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