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<\/figure>\nThis article is a part of your HHCN+ Membership<\/h2>\n<\/p>\n<\/div>\n
Last week, Sen. Susan Collins (R-Maine) introduced a bill that would reset the home health base payment rate and give the Centers for Medicare & Medicaid Services (CMS) new fraud-fighting tools. <\/p>\n
The bill serves as a microcosm of how lawmakers appear to view the home health industry: with equal parts support and suspicion. <\/p>\n
It\u2019s a frustrating contradiction in many ways, particularly insofar as the suspicion creates burdens and obstacles \u2013 such as the moratorium on new Medicare enrollments for home health agencies \u2013 that make it difficult for the sector to demonstrate its full potential for driving down costs and improving outcomes, and win greater support. <\/p>\n
This bill may still be a step in the right direction, given that it addresses one of the sector\u2019s most critical issues related to Medicare payment methodology. Still, the bill may also offer a preview of the kind of home health policy most likely to gain traction in Washington: fraud first, evolution second. <\/p>\n
Two elements of the bill particularly caught my eye: expanded fingerprinting requirements and, of course, the proposed \u201creset\u201d of the base Medicare payment rate. <\/p>\n
In this week\u2019s exclusive, members-only HHCN+ Update, I unpack two elements of the bill, offering analysis and key takeaways, including: <\/p>\n
\u2014 Why anti-fraud efforts won\u2019t make regulation more efficient anytime soon <\/p>\n
\u2014 Why better payment rates depend on better fraud controls <\/p>\n
The fingerprinting burden<\/strong> <\/h3>\nI honestly had not thought much about home health provider leaders getting fingerprinted during new enrollments or changes of ownership until the most recent episode of HHCN+ TALKS<\/a>, with Choice Health at Home founder and CEO David Jackson. <\/p>\nWhen I saw mention of an expansion of fingerprinting in the new bill, my mind immediately went to this quote from my conversation with Jackson: <\/p>\n
\u201cThe enrollment process and how states and the federal government deal with that, it definitely can be improved,\u201d Jackson said. \u201cI probably have had my fingerprints taken 15 times this year. To me, there are some things that could be maybe moved forward from a technology perspective. This is a great time for them to look at that and say, \u2018How do we bring this into the 21st century? What\u2019s the opportunity there?\u2019\u201d <\/p>\n
Under current requirements<\/a>, CMS assigns newly enrolling home health agencies (HHAs)\u2014and enrolled HHAs that submit a change-of-ownership application or report any new owner\u2014to the high-risk screening category. At that level, CMS requires all individuals with a 5% or greater direct or indirect ownership interest in the HHA to submit fingerprints for a national background check. These fingerprints must be submitted with a Medicare enrollment application or within 30 days of a Medicare contractor\u2019s request. <\/p>\nOf course, not all providers are growing as rapidly as Choice and therefore are not required to submit fingerprints as often. But Jackson made an important point: this process could be moved into the 21st<\/sup> century. It seems totally plausible that CMS could update its systems and requirements so that an owner\u2019s fingerprints, once collected, could be kept on file in a centralized record. Doing so could save time and hassle for both providers and CMS. <\/p>\nThe new bill isn\u2019t designed to modernize CMS\u2019 enrollment practices, so I\u2019m not suggesting that this was the opportunity to overhaul the fingerprinting process. But this bill does expand existing fingerprinting requirements. <\/p>\n
Namely, the bill would expand the population subject to fingerprinting by adding the administrator of a newly enrolling HHA that CMS designates as posing an \u201cextreme risk of fraud,\u201d even if that administrator does not have a 5% ownership interest. <\/p>\n
I\u2019m not saying it\u2019s a bad idea to have HHAs most likely at risk of fraud submit their fingerprints. <\/p>\n
But what this bill shows is that, under the current program integrity crackdown, we\u2019re unlikely to see the kind of innovation that would improve efficiency in the Medicare home health enrollment system. The focus is on rooting out fraud, which means compliant providers will have to wait before they can expect to see any meaningful changes to reduce administrative burden in these ways. I think a more complete modernization effort could pursue both goals: Stronger screening of high-risk organizations and a more efficient process for responsible owners and operators who are repeatedly submitting the same information for enrollment transactions. <\/p>\n
Rethinking the fraud calculus<\/strong> <\/h3>\nIn speaking with industry experts about the past few years of changes to the Medicare home health base payment rate, the element of CMS\u2019 decision-making that has most come into question is its methodology. \u00a0<\/p>\n
For the last few years, CMS proposed and finalized aggregate cuts to the base payment rate. This year, CMS proposed an aggregate increase \u2014 but still proposed to continue temporary recoupments. <\/p>\n
\u201cWhile the proposed rate update results in increased payments relative to last year \u2014 a reflection of our continued advocacy and a much-needed reprieve for providers under the stress of increasing costs \u2014 the Alliance remains focused on working to stop unwarranted temporary adjustments that are based on a flawed methodology with underlying data integrity issues,\u201d Jennifer Sheets, CEO of the National Alliance for Care at Home (the Alliance), said in a statement<\/a>. <\/p>\nThe Medicare Home Health Payment Integrity and Protection Act of 2026, if passed, promises to reset the standard prospective payment amount and suspend permanent and temporary adjustments, as well as conform protection for benchmarks and value-based programs. For 2027, the bill would make the standard prospective payment amount $2,382.87, per the bill text. <\/p>\n
The bill would effectively reset CMS\u2019 methodology. <\/p>\n
The Alliance\u2019s reaction to the Medicare Home Health Payment Integrity and Protection Act of 2026 said that the bill would correct CMS\u2019 flaws in calculating Medicare rate updates, given that CMS has determined the cuts on data \u201ctainted by the inclusion of fraudulent providers in the rate analysis.\u201d <\/p>\n
I think the fraud-fighting measures of this bill and the payment reset go hand-in-hand. Without the sections that give CMS extra power to fight fraud, it\u2019s unlikely Collins and Blackburn, two Republican lawmakers representing the party whose tagline has basically become \u201cfraud, waste and abuse,\u201d would offer a positive reset for the payment landscape. <\/p>\n
So while providers are unlikely to see meaningful process improvement like the kind mentioned in the section above, this bill shows that any home health transformation likely to gain traction will have to balance the government\u2019s focus on the industry\u2019s risk of fraud. \u00a0<\/p>\n
When I saw mention of an expansion of fingerprinting in the new bill, my mind immediately went to this quote from my conversation with Jackson: <\/p>\n
\u201cThe enrollment process and how states and the federal government deal with that, it definitely can be improved,\u201d Jackson said. \u201cI probably have had my fingerprints taken 15 times this year. To me, there are some things that could be maybe moved forward from a technology perspective. This is a great time for them to look at that and say, \u2018How do we bring this into the 21st century? What\u2019s the opportunity there?\u2019\u201d <\/p>\n
Under current requirements<\/a>, CMS assigns newly enrolling home health agencies (HHAs)\u2014and enrolled HHAs that submit a change-of-ownership application or report any new owner\u2014to the high-risk screening category. At that level, CMS requires all individuals with a 5% or greater direct or indirect ownership interest in the HHA to submit fingerprints for a national background check. These fingerprints must be submitted with a Medicare enrollment application or within 30 days of a Medicare contractor\u2019s request. <\/p>\n Of course, not all providers are growing as rapidly as Choice and therefore are not required to submit fingerprints as often. But Jackson made an important point: this process could be moved into the 21st<\/sup> century. It seems totally plausible that CMS could update its systems and requirements so that an owner\u2019s fingerprints, once collected, could be kept on file in a centralized record. Doing so could save time and hassle for both providers and CMS. <\/p>\n The new bill isn\u2019t designed to modernize CMS\u2019 enrollment practices, so I\u2019m not suggesting that this was the opportunity to overhaul the fingerprinting process. But this bill does expand existing fingerprinting requirements. <\/p>\n Namely, the bill would expand the population subject to fingerprinting by adding the administrator of a newly enrolling HHA that CMS designates as posing an \u201cextreme risk of fraud,\u201d even if that administrator does not have a 5% ownership interest. <\/p>\n I\u2019m not saying it\u2019s a bad idea to have HHAs most likely at risk of fraud submit their fingerprints. <\/p>\n But what this bill shows is that, under the current program integrity crackdown, we\u2019re unlikely to see the kind of innovation that would improve efficiency in the Medicare home health enrollment system. The focus is on rooting out fraud, which means compliant providers will have to wait before they can expect to see any meaningful changes to reduce administrative burden in these ways. I think a more complete modernization effort could pursue both goals: Stronger screening of high-risk organizations and a more efficient process for responsible owners and operators who are repeatedly submitting the same information for enrollment transactions. <\/p>\n In speaking with industry experts about the past few years of changes to the Medicare home health base payment rate, the element of CMS\u2019 decision-making that has most come into question is its methodology. \u00a0<\/p>\n For the last few years, CMS proposed and finalized aggregate cuts to the base payment rate. This year, CMS proposed an aggregate increase \u2014 but still proposed to continue temporary recoupments. <\/p>\n \u201cWhile the proposed rate update results in increased payments relative to last year \u2014 a reflection of our continued advocacy and a much-needed reprieve for providers under the stress of increasing costs \u2014 the Alliance remains focused on working to stop unwarranted temporary adjustments that are based on a flawed methodology with underlying data integrity issues,\u201d Jennifer Sheets, CEO of the National Alliance for Care at Home (the Alliance), said in a statement<\/a>. <\/p>\n The Medicare Home Health Payment Integrity and Protection Act of 2026, if passed, promises to reset the standard prospective payment amount and suspend permanent and temporary adjustments, as well as conform protection for benchmarks and value-based programs. For 2027, the bill would make the standard prospective payment amount $2,382.87, per the bill text. <\/p>\n The bill would effectively reset CMS\u2019 methodology. <\/p>\n The Alliance\u2019s reaction to the Medicare Home Health Payment Integrity and Protection Act of 2026 said that the bill would correct CMS\u2019 flaws in calculating Medicare rate updates, given that CMS has determined the cuts on data \u201ctainted by the inclusion of fraudulent providers in the rate analysis.\u201d <\/p>\n I think the fraud-fighting measures of this bill and the payment reset go hand-in-hand. Without the sections that give CMS extra power to fight fraud, it\u2019s unlikely Collins and Blackburn, two Republican lawmakers representing the party whose tagline has basically become \u201cfraud, waste and abuse,\u201d would offer a positive reset for the payment landscape. <\/p>\n So while providers are unlikely to see meaningful process improvement like the kind mentioned in the section above, this bill shows that any home health transformation likely to gain traction will have to balance the government\u2019s focus on the industry\u2019s risk of fraud. \u00a0<\/p>\nRethinking the fraud calculus<\/strong> <\/h3>\n