By: Mendi Lancaster, MS, CCC-SLP, TSHA StAMP
On June 26, 2024, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule for 2025 that would continue payment reductions to the home health sector. These cuts are a result of the disparity between the cost of providing care and payments received from Medicare. Per the American Speech-Language-Hearing Association (ASHA), CMS data reveals payments to home health agencies are 32% higher than the cost of delivering care. CMS hopes to offset this imbalance (if the proposed rates are finalized) by decreasing payments by 4% in 2025, with the national average speech-language pathology payment rate of $204.86. CMS noticed a decrease in therapy provision since the Patient-Driven Groupings Model (PDGM) was implemented in 2020. CMS proposes a new condition of participation that would require home health agencies to develop a “patient acceptance service policy,” which would address home health agencies’ capacity to provide patient care, including the caseload and case mix, staffing levels, and competencies of the therapy staff. ASHA is reviewing the entirety of the proposed ruling, making sure there is not an increase in administrative burden on the home health agencies and therapists, and ensuring that agencies are held accountable for providing the necessary services a Medicare patient needs in the multidisciplinary framework. CMS also is proposing four additional and one updated social determinants of health (SDOH) items associated with living situation, food security, ability to pay utilities, and access to transportation for home health patients. By clinicians collecting this data, optimal health outcomes will be supported.
Comments to the proposed home health rule must be received by August 24 with the final rule to be expected in early November with implementation set for January 1, 2025.
On July 10, CMS issued a proposed rule on policy changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues for 2025. Details on the rule are not available at time of published article, but the comment period will be open until September 9 with the final rule issued in November 2024 for implementation on January 1, 2025.
It is important for speech-language pathologists and audiologists to review all of these proposed changes and advocate for our professions and our patients. As our cost to provide services continues to rise, we must be diligent in our advocacy efforts for improvements in the payment structure while maintaining efficiencies in the workplace.
ASHA also is advocating continuously for a permanent telehealth extension for our services.
Please stay engaged with the public policy initiatives by visiting the advocacy page of ASHA at https://www.asha.org/advocacy.