The Centers for Medicare & Medicaid Services (CMS) has proposed a new rule that could significantly impact home health agencies in 2025. Key points include:
Medicare reimbursements to home health agencies may decrease by 1.7% (about $280 million) in 2025.
The decrease stems from adjustments related to the Patient-Driven Groupings Model (PDGM), implemented in 2020 to align payments with patient care needs.
CMS has already finalized reductions in 2023 and 2024 to account for differences between assumed and actual behaviors under PDGM.
The proposed rule includes recalibration of case-mix weights and low utilization payment adjustment thresholds.
Updates to the Home Health Quality Reporting Program are proposed, including new standardized patient assessment data elements focusing on social determinants of health.
Changes to Home Health Conditions of Participation are suggested to minimize care delays, including requirements for patient acceptance policies and public information on services offered. More info Medicare home health payments to dip 1.7% in CY 2025
The National Association of Home Care and Hospice has previously sued HHS over payment reductions.
This proposal continues CMS’s efforts to refine the PDGM and ensure appropriate Medicare payments to home health agencies. Stakeholders should watch for further developments as the rule progresses.