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FPTA Members need to Engage – Fight Back – PDGM Home Health Services

Tuesday, November 26, 2019  

FPTA Members need to Engage – Fight Back – PDGM Home Health Services


APTA has provided numerous tools for members to battle against inappropriate use of the PDGM in the Home Health setting. When implemented January 1, 2020, the Patient-Driven Groupings Model (PDGM) adopted by the US Centers for Medicare and Medicaid Services (CMS) will shift home health payment toward a system that focuses on clinical characteristics and other patient information, and away from therapy service visit thresholds. It is not intended to be used to make treatment or staffing decisions that reduce or compromise patient care.

APTA PDGM Resource Page located at:

When members learn of reports of lay-offs, APTA is tracking layoffs that are associated with PDGM implementation and sharing those reports with our contacts at CMS. CMS is keeping companies that layoff therapists on their radar, and those entities could likely find themselves being audited in the near future. Individuals can report information on PDGM-associated layoffs to advocacy@apta.orgThey should also report this info directly to CMS and OIG at:

APTA is advocating in support of Senate bill 433 and HR 2573 in the US Congress. This bill will refine payments in the new home health payment system to ensure behavioral-based payment adjustments are based on evidence and observed data, not on assumptions of provider behavior. One concerning aspect of PDGM is that the Centers for Medicare and Medicaid Services (CMS) will make home health payment adjustments based on behavioral assumptions as opposed to evidence or actual provider billing data. Basing payment adjustments on assumptions of provider behavior instead of actual data is arbitrary, could create instability for home health services during this time of reform, and could potentially limit patient access. S. 433 and H.R. 2573 addresses this concern by requiring CMS to implement adjustments to home health reimbursement rates only after behavioral changes by home health agencies (HHAs) that affect Medicare spending actually occur.  

Engage and take action at

Click HERE to download: What You Should Know About the Patient-Driven Groupings Model for Home Health Services

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