Home health agencies are navigating several new and upcoming Medicare payment policy changes. These changes include 1) revised targeting and beginning of phase out of rural add-on payments that became effective in 2019; 2) the Patient-Driven Groupings Model (PDGM), a new prospective payment system scheduled to be implemented in 2020; and 3) the Home Health Value-Based Purchasing (HHVBP) demonstration.

All Medicare-certified home health agencies (~12,000) serving fee-for-service beneficiaries will be impacted by the PDGM. The revised rural add-on payments impact all home health agencies that serve rural beneficiaries. About 2,000 home health agencies are currently participating in the HHVBP demonstration, of which 13% are rurally-located.

The cumulative impact of these policies on home health agencies had not been explored. This study estimated the cumulative impact on home health agencies, comparing home health agencies operating under one, two, or all three policies. We hypothesized there would be differential impacts based on rural-urban status, community factors, and home health agency characteristics. We estimated and reported impacts by rural-urban status, community factors, and home health agency characteristics. We compared the cumulative impacts with the separate impacts of the three individual payment policy changes. We then identified rural counties where access to and/or quality of home healthcare may be most impacted by the cumulative payment policy changes.

Publications

• Estimated Impacts of Multiple Payment Policies on Rural-Serving Home Health Agencies
  Policy Brief
  WWAMI Rural Health Research Center
  Date: 07/2024
  This brief examines the estimated impact of three Medicare payment policy changes on home health agency (HHA) reimbursement by rural-serving status, geographic location, and select HHA characteristics.