PERSPECTIVE: REVIEW OF NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE V. BECERRA

In 2020, over 3 million people received home health care services in the United States [1]. Home health care services are covered under the Medicare program and administered by the Centers for Medicare & Medicaid Services.  Section 1395 of . 42 outlines the process of how Medicare pays for home health services through the Home Health Prospective Payment System. At issue is a final rule that will implement revisions to the payment system.

The National Association for Home Care & Hospice (“NAHC”) filed a complaint in the in the U.S. District Court for the District of Columbia against the Secretary of the United States Dept. of Health & Human Services because Medicare payments provided by the Centers for Medicare and Medicaid Services under the final rule were not budget neutral and improperly calculated per the Bipartisan Budget Act of 2018, resulting in a decrease in payments.

In the complaint, the plaintiff challenges the final rule stating: “… the rule violates the Medicare statute’s plain language and arbitrarily and capriciously sets payment rates at a level that will result in substantial financial harm to numerous home health agencies across the country [2].” The plaintiff also notes “Congress instructed the Secretary to compute a standard prospective payment amount for the unit of service to be based on aggregate home health agency costs as reflected in the most recently audited home health costs reports at that time [3].”

05 § 551 of the Administrative Procedure Act permits judicial review of agency actions, findings, and conclusions that are not in accordance with law or are in excess of statutory jurisdiction, authority, or limitations. As a form of redress, the plaintiff requests an injunction that directs the Secretary to withdraw or suspend the final rule and withhold applying the new payment system until the rule has been revised [4].”