Congressman Ritchie Torres (NY-15) led New York’s Congressional Delegation in a letter to President Joe Biden, Director of the Office of Management and Budget Shalanda Young, and Administrator of the Centers for Medicare and Medicaid Services Chiquita Brooks-LaSure to express disapproval of the Centers for Medicare & Medicaid Services (CMS) CY2025 proposed payment rule.

Home health care is the safest, most preferred choice for seniors and Americans with disabilities. These proposed changes threaten home healthcare providers’ ability to continue to care for the nation’s seniors and people with disabilities, will exacerbate an existing labor shortage within the healthcare industry, and will disproportionately impact vulnerable and minority communities.

According to the Health Affairs Journal, Black, Hispanic, and low-income residents already have lower access to home health services, and the care they do have access to is of lower quality. Further, Black and Hispanic elderly individuals reside in nursing homes at higher rates than their white counterparts because of inequitable access to services such as home health.

The letter was signed by all rank-and-file members of the New York Congressional Delegation.

Dan Savitt, CEO of the nonprofit VNS Health, New York’s largest home health provider, said the following:

“The proposed CMS Medicare cuts turn a blind eye to the essential needs of thousands of vulnerable New Yorkers. While more and more people are being referred to home health care, fewer are actually getting the care they need because of ongoing workforce shortages and ‘home health deserts’ where patients and communities are starved of critical services. VNS Health applauds Congressman Torres for his leadership and New York’s Congressional Delegation for coming together in a bipartisan call to reconsider these cuts. We also salute Leaders Schumer and Jeffries for their steadfast commitment to ensuring that seniors across the country have access to sustainable, quality home health care.”

Al Cardillo, President of New York’s Home Care Association (HCA) said the following:

“Our state’s Congressional Delegation deserves the appreciation of all New Yorkers for this direct, impassioned request to the White House, President Biden, and his Cabinet officials to halt these unprecedented CMS’s cuts to Medicare home health. Led by Representative Ritchie Torres, the New York Delegation is making it clear that these pending Medicare cuts will further threaten the already severe underfunding of home health services and the related, unprecedented shortages of nurses and fellow direct care staff. We hope that the President and Administration will positively respond to the Delegation’s concerns that CMS’s mounting cuts will only further diminish access to home health services at the very time that the need for them is ever rising. Thank you to our Congressional Members for taking this strong stand on behalf of your constituents in need.”

The letter reads as follows:

“As members of the New York State Congressional delegation, we write to express our disapproval of the Centers for Medicare & Medicaid Services (CMS) CY2025 proposed payment rule, which will disrupt access to home health services through an unprecedentedly steep payment reduction. The proposed rule threatens the ability of home health care providers to care for our nation’s senior citizens, people with disabilities, and other vulnerable populations. We urge you to consider pausing this rule change and refine your approach in determining budget neutrality in home health.

“In June, CMS unveiled the CY2025 proposed home health rule, introducing a permanent 4.067% payment adjustment. This cut, on top of previous negative payment adjustments since 2020, amounts to a proposed payment reduction of more than $2.6 billion in 2025 and a cumulative impact of $8.1 billion from 2020 to 2025. In addition to immediate cuts in the name of budget neutrality, CMS is also planning an alarming “clawback” of at least $4.4 billion in Medicare reimbursement that was provided during the COVID-19 public health emergency (PHE) from 2020-2023. CMS has also finalized a wage index cut of up to 5% in many geographic regions across New York State, resulting in combined cuts exceeding 8% in 21 counties. These cuts will not only worsen the economic condition in the state of New York, but also deny additional patients the necessary home health care, and lead to additional strains to an already overcrowded hospital system.

“These ongoing reimbursement cuts and related workforce shortages are having a direct impact on patient care. We would like to highlight a few sobering statistics that lay out the gravity of their issues:

• There was an estimated 24.6% decline in Medicare fee-for-service (FFS) and Medicare Advantage (MA) home health admissions across NYS in 2023 compared to 2019, resulting in more than 180,000 enrollees who needed but did not receive home health care from 2020-2023.
• All regions are impacted, but upstate regions have been hit particularly hard, including 40.5% in the Finger Lakes, 36% in Central New York, and 34.6% in the Capital District. New York City saw a 22.9% decrease in home health admissions, with the Bronx experiencing the steepest decline at 33.3%, and Queens seeing the largest number of residents lose access to home health care – more than 20,000 Medicare enrollees.
• New York State saw a 13% decline in the number of active HHAs between 2019 and 2023, losing 19 agencies during this period; at least two more agencies have closed in 2024.
• The average length of a hospital stay for NYS patients referred to home health care increased 9% from 2019-2023, indicating patients are waiting longer to be discharged safely.
• These statistics are consistent with other state and national trends: Nationally, there was a 22.4% decline in the rate of Medicare enrollees receiving home health care between 2019-23. Every state experienced a loss of access, ranging from 3.6% (North Dakota) to 32.3% (Maine).8 An estimated 2.6 million patients annually who are referred to home health care are never accepted by a home health agency.

“In 2018, a bipartisan majority in Congress insisted on budget neutrality when transitioning from the previous home health payment system to the Patient Driven Groupings Model. Budget neutrality is yet to be achieved in the transition to the new payment model, and CMS has instead instituted an unauthorized rebasing of home health payments that result in billions of dollars in cuts. This approach ensures neither stability nor the preservation of vital services provided to seniors and people with disabilities that heavily rely on the home health benefit. We support the suggestion of our home health care providers and believe their recommendations should be viewed and considered by CMS as a viable alternative to the proposed rule. CMS should be consistent in how they treat home health by applying the same budget methodology principles as it does in analyzing budget neutrality in the skilled nursing facility payment system.

“If approved, the proposed rule will not only further disrupt the services that patients currently receive, but also deepen public health disparities among some of the most vulnerable communities in our state and country. Studies have shown that Black, Hispanic, and low-income residents have poor access to home health services, and when they do have access, it is lower-quality care.10 Black and Hispanic elderly individuals and those who live in rural areas reside in nursing homes at higher rates than their White counterparts because of inequitable access to services such as home health. We have heard from New York’s largest home health provider that they have had to turn away more than 18,000 patients who needed care in 2023 because they lacked capacity, the majority of whom live in communities that already lack access to health care. This will further exacerbate the formation of “home health deserts” across the state and the country, where there will be virtually no workforce available to provide home health care in urban, rural, and suburban communities. These cuts would further the racial and income disparities in home health care.

“For our most vulnerable communities, home health is by far the safest, most accessible choice to receive lifesaving medical treatment. Studies have shown that a growing number of Medicare patients prefer home health to treatment in a post-acute facility, but the industry currently faces several challenges that are already causing disruptions to patient care.11 Further, the growing demand for workers outpaces supply and the industry reels from the resulting financial pressures. The reimbursement reductions in the proposed rule will only exacerbate these issues, further crippling the efficacy of the home health care delivery system and burdening millions of Americans and numerous underserved communities with inadequate home health care.

“Thank you for your prompt attention and full and fair consideration of our concerns, consistent with applicable agency guidelines, and your commitment to the health and protection of our communities. We look forward to your prompt reply.”

A PDF of the letter can be found here.