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With more eyes than ever on home-based care, there are a number of legislative and regulatory developments that will be critical for providers to stay on top of.

For providers like Help at Home, which is working in the Medicaid space along with private pay, the short-term gains have been apparent.

“If you took what’s happening this year and last year and put it in a bubble, I would say the funding and reimbursement has been encouraging,” Deb Oberman, senior vice president of government relations at Help at Home, said during a panel discussion last month at HHCN’s Capital+Strategy conference. “If you take that bubble off, and you think about what we all expected to be a precursor to Build Back Better, it was all looking quite good.”

That said, Oberman stressed that the future was still uncertain.

“There was a lot of recognition of the importance of home-based care and home and community-based supports, and we were seeing funding streams like we really haven’t seen before,” she said. “We were also seeing a recognition, both at the federal and state level, that you needed consistent, long-term viable funding streams. I’d say short-term, it’s encouraging and in the right direction, but long-term, there’s still a question mark.”

The Vistria Group-backed Help at Home is one of the larger home care organizations in the US The company has more than 170 branch locations across 11 states. It recently entered into New York with two major acquisitions.

At Help at Home, 90% of the company’s funding comes from state government programs from Medicaid.

On the other end, when looking at the Medicare reimbursement landscape for home health providers, William A. Dombi, the president of the National Association for Home Care & Hospice (NAHC), believes that the Centers for Medicare & Medicaid Services (CMS) will likely examines budget neutrality for the shift to Patient-Driven Groupings Model (PDGM).

“It was skipped over the last couple of years, data was not yet available on it,” he said during the panel discussion. “The methodology they suggested they might use sent alarm bells to everybody — a 6% cut for 2020 would be there. We think that is a fatally flawed methodology. We’re gearing up for a battle with with CMS on this, should they pursue that methodology. We anticipate the potential for a serious World War III kind of fight with them.”

Dombi noted that it’s likely that CMS owes home health agencies, rather than providers owing Medicare programs, due to rise of the delivery of wound care services and the reduction in therapy services.

Another upcoming change in home health is the national expansion of the Home Health Value-Based Purchasing (HHVBP) Model, but Dombi believe this will likely be “business as usual” for providers.

“The home health agencies have long focused on quality of care outcomes, because they had to compete, whether it was on star ratings or Home Health Care Compare,” he said. “Now dollars are involved in it. When we looked at what happened in the nine states with the demonstration program, it really wasn’t disruptive. It triggered improvements by all providers, essentially, raising performance was a good thing there.”

However, Dombi did express concern about the way HHVBP’s expansion places providers in direct competition with organizations in other states.

As far as legislative updates, Oberman expressed optimism about the future of a version of Build Back Better.

“The term Build Back Better — we’re not hearing that anymore,” she said. “But through the Partnership for Medicaid-Home Based Care, and others, we’ve had a number of recent virtual meetings on the Hill. I think if it was completely dead in the water, people would be calling in two months. It would be, ‘I’ll talk to you in a little while.’ They’re inviting us in and rolling up their sleeves.”

That said, Oberman doubts Build Back Better will be the same exact package as it was before.

Looking ahead, John Olajide, the president and CEO of Axxess, believes its imperative for providers to proactively engage in policy, regulatory and reimbursement discussions.

“I always tell people that when you don’t have a seat at the table, you’re on the menu,” he said during the panel discussion. “As an industry, we’re always reacting to a lot of those changes and it shouldn’t just be reactionary. We want to make sure we’re engaging in a more active manner, at the policy level with CMS. Let’s have a conversation about what needs to happen, and have datasets, so that we can make those arguments.”

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