This article is part of the HHCN+ membership
As the home health industry still awaits final Medicare home health payment rules, the National Home Health Alliance (Alliance) is ready to go “in earnest” with a legislative backup plan.
Scott Levy, the alliance's chief government affairs officer, said the organization isn't just focused on the highest payouts. Once the final rule is issued, the organization will scrutinize the Centers for Medicare and Medicaid's (CMS) methodology and implementation plan. At the same time, the organization stands ready to advance the Home Health Stabilization Act of 2025 if the final rule includes significant reductions in home health Medicare rates.
Levy said the current legislative environment and several key industry factors combine to make the bill more likely to pass than previous attempts to protect Medicare's home health benefits.
The content of the final Medicare home health payment rule will partially determine the Alliance's approach toward 2026. The organization's plan for the new year also includes a major deregulation push, with the 80/20 rule being top of mind.
Home Health Care News spoke with Levy about the practical consequences of the Medicare home health payment rules, the likely fate of the Home Health Stabilization Act, and why 2025 is a “transformational year” for the industry.
Below is the conversation, edited for length and clarity.
HHCN: What are the different practical outcomes we might see when the Medicare home health payment rules are finally announced?
Levy: Since June 30th, we've been working very hard, in a war room mindset, to create the most comprehensive comment letter possible. But ultimately, when you submit your policy idea to CMS, it's in their hands. We know there is significant support for them, so we are confident that there will be no 9% cut. We do not believe that the final rule will be the same as the proposed rule. …I don't want to give the false impression that we know, but I think our advocacy has been important.
I think we'll see some meaningful movement, but will it be significant enough for this industry? Because this is the biggest rule we've ever proposed. Our public message has been that we understand and appreciate the relief CMS has received over the past years. But halving is not enough for the industry at this point. Because even if you go from $1 billion to $500 million, it's still going to have a huge impact on this sector.
What is the contingency plan if the final rule is similar to the proposed rule?
It’s not just about the looks of the rules or the numbers, it’s about how we got there. Are there any changes in how we look at measurements and methodologies and how we implement them? Are they accepting some of the meaningful recommendations that have been given to the industry, including some of what the Alliance put in our letter? So we're going to take some time to really understand how they got there, but we're ready, if necessary, to continue to push forward the Home Health Stabilization Act that was introduced in the House by Rep. Hahn and Rep. Sewell. And we call on our supporters and advocates to do just that.
Once there are rules that require us to move forward on the legislative path in earnest, we will be ready.
There were other bills designed to protect Medicare home health benefits, but they were not passed. Can the industry really place its hopes in the Home Medical Care Stabilization Act?
There are many differences between previous legislation and its goals, and the purpose of the Home Health Care Stabilization Act in the first place.
Second, we are now in a different legislative environment. This closure did nothing to advance this bill into meaningful standing order progress. We have been having frequent conversations with Capitol Hill, Congressional offices, and staff about why this is important if this rule turns out badly. However, the previous law was actually a significant change to policy. There is no time now to make major changes to policy. What we are looking for in the Stability Act is a pause.
We need time to look deeper internally at how this happened. If CMS does not have the ability to seriously investigate (public comments), they should do so, but if CMS chooses not to do so, we need time. Last year we were considering freezing major reforms, not that that's not the next step that shouldn't come, but not now, at (close to) the end of the year. It will be a sprint. Compared to past years, I think there are some significant differences between both the law and the environment, albeit instructive.
Also, the industries are in very different positions. The first year of introduction of the first bill in summer 2022 was immediately after the first round of cuts proposed in the proposed rules for the 2023 calendar year. Now three years on, there has already been a permanent reduction of 9%. So this is not the first or second. We're going into our fourth year, so that's a big difference as well.
Besides the final rule, what other regulations or policies are currently in flux?
We know that providers experience a lot of regulatory burden, so we want to be able to take advantage of this administration's goal of providing some degree of regulatory relief. So, with a focus on deregulatory executive orders, we are reiterating some of the things we raised in our annual RFI at the beginning of this administration…particularly home health and hospice, an industry that is currently under strain at staffing levels. We want to make sure that we highlight and recognize the policies that are actually burdensome to bedside clinicians, policies that take away their ability to provide care by simply checking a bureaucratic box that doesn't necessarily help them provide care. These are the areas that we intend to focus specifically on later this year and into next year, refining not only our policy goals but also areas that align directly with the current administration's goal of reducing these burdens.
What regulations would you like to see repealed? Does that include the 80/20 rule?
80/20 is at the top of the list. When not actually used in patient care, some of the paperwork that clinicians have to complete and its impact on timeliness is another issue. We have a whole list submitted to CMS for both home health, hospice, and HCBS, but 80/20 is definitely the focus.
As we near the end of 2025, what are the key takeaways for this year?
This year has been transformative for the industry from a structural perspective, with alliances coming together to take the lead in care at home policies.
However, this first year has been a very busy one, starting with the settlement and its impact on HCBS. On the hospice side, we make sure that the integrity of hospice benefits is maintained and remains within the piece rate structure and within Medicare Advantage. We started working on home health care issues in January. We received a message in advance as to whether this would happen. These three are really big things that were covered this year.
A lot of that is actually going to be carried over into 2026. The reconciliation bill has been passed, but now we need to implement it. So how that plays out at the state level will shape much of Medicaid efforts in 2026. And continuing to block any hospice efforts will be a top priority for that service department.
And when it comes to home health care, by the time 2025 ends, a lot will be said about what 2026 will look like. Without an active home health system, we don't know how home health care actually works. I don't see how we can reduce institutional care if we don't have the workforce to care for people in the home. These are things that the administration that we know cares about very much, and we want to continue down that path next year and work on those solutions rather than continue to fight based on past policies.
