Home Health & Hospice Week

Extended timeline, potential exemptions for small and rural providers may lessen the damage.

Home- and community-based services providers are reeling from news of the 80-20 rule’s finalization, but at least they did manage to win a few concessions in the policy.

Perhaps most importantly, the final rule released on April 22 (see story, p. 106) extends the implementation timeline for the 80-20 requirement. The Centers for Medicare & Medicaid Services bumps it from four to six years, with a deadline in 2030 instead of the proposed 2028.

“We were very pleased to see the extension to six years for implementation, giving states and providers a substantial amount of time to address the complexities of the rule,” Addus HomeCare Corp. CEO Dirk Allison says in a release. “We will have at least six years to prepare for final implementation,” Allison adds.

Other positive changes include:

• Exemptions. States have “the option to establish: (1) a hardship exemption based on a transparent state process and objective criteria for providers facing extraordinary circumstances and (2) a separate performance level for small providers meeting state-defined criteria based on a transparent state process and objective criteria,” CMS spells out in its fact sheet on the rule. It “also exempts the Indian Health Service and Tribal health programs … from complying,” the agency adds.

“This policy would … allow states to take into account the unique experiences that small home care providers and providers in rural areas face while ensuring their employees receive their fair share of Medicaid payments and continued training as well as the delivery of quality care,” the White House says in its release on the rule.

States will have to submit reports on the exemptions to CMS annually, unless “a small proportion of providers … less than 10 percent of the total number of providers of services” qualify, CMS directs in the rule.

Stay tuned: “We plan to issue guidance on both the small provider performance level and the hardship exemption and encourage States to consult with CMS as they develop their criteria,” the rule says.

• A looser 80 percent calculation. In response to comments on the proposed rule, CMS adds in the final rule “a definition of excluded costs” and revises “the definition of direct care worker … to clarify that clinical supervisors are included in the definition of direct care workers,” according to the rule.

Excluded costs — meaning those that won’t go into the calculation — include “training costs (such as costs for training materials or payment to qualified trainers); travel costs for direct care workers (such as mileage reimbursement or public transportation subsidies); and costs of personal protective equipment for direct care workers,” the rule specifies.

Including clinical supervisors as direct care workers will help boost that 20 percent figure, observers note. CMS had originally planned to exclude them.