State and Federal Policy Updates 8-19

State update

A new home health designation rule goes into effect on October 1, 2019. The rule is essentially a licensing regulation and covers the core services home health and hospice agencies provide including skilled home health (i.e., nursing and therapy services), hospice and long-term care at home. The existing rule has been in effect since 2007 and was out of alignment with federal regulations. The VNAs of Vermont supported the effort to revise the rule and believe it includes a number of improvements. Some elements of the rule reflect statutory requirements that are also out of date but cannot be adjusted without legislation. The new rule isn’t yet posted but a clean version is available HERE. The VNAs of Vermont is working on a crosswalk between the current rule and the final rule and will provide that to members when it is complete.

Federal update

On August 1, CMS released a final 2020 Hospice Payment Rule. The news for Vermont isn’t good. While technically the rule includes a rate increase for “routine” hospice care (the most commonly billed hospice service in Vermont), the increase is offset by other changes. In a nutshell, three other levels of hospice care are getting “rebased,” i.e., increased to better reflect the cost of care. While by itself that’s a positive development, because of Congressional budget-neutrality rules, those increases must be offset by a cut to routine hospice care.
Meanwhile, Vermont home health and hospice agencies continue to prepare for the biggest change to the Medicare home health payment system in decades—the Payment Driven Groupings Model. Vermont agencies are projecting a wide range of impacts with some agencies expecting to do worse under the new system and some hoping to fare a little better. For all agencies, implementing a new system has been costly as systems are upgraded and staff are re-trained. As we head into the fall, agencies will be reaching out to their physician colleagues to educate them about the changes.

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