Last summer, the National Association for Home Care & Hospice (NAHC) made waves when it filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) over Medicare home health payment calculations.
Last week, a federal court in Washington D.C., dismissed NAHC’s lawsuit against CMS and HHS.
The lawsuit claimed that CMS and HHS utilized an “invalid” methodology to decide payment, and that recent home health payment cuts were unlawful.
“The primary claim in our lawsuit is that the methodology violated the plain language of the Medicare law,” NAHC wrote in its latest report.
CMS implemented a 3.925% rate reduction for 2023, and a 2.89% one for 2024.
On April 26, the U.S. District Court for the District of Columbia ruled that NAHC skipped an agency review process prior to suing.
“The Court ruling addresses a combination of the NAHC arguments and the defenses presented by the U.S. Department of Justice on behalf of CMS,” NAHC wrote. “DOJ argued that the Court did not have the power to hear any challenges to the PDGM budget neutrality adjustment methodology, that NAHC failed to exhaust all administrative appeal steps, and that the challenged methodology was in compliance with the law.”
Still, NAHC noted that the Court ruled in its favor on something it considers a crucial element of the case.
“[The court rejected] DOJ’s argument that all judicial review was precluded on anything related to the PDGM system,” NAHC wrote. “The Court specifically held that NAHC could challenge the budget neutrality adjustment methodology once administrative remedies are exhausted. Of further note, the Court did not rule on or evaluate the merits of the NAHC claim that the methodology violated Medicare law.”
Last year, the Biden administration asked a federal judge to throw out NAHC’s lawsuit against CMS and HHS.
Looking ahead, NAHC is considering its next move. One of the things the organization is thinking about is appealing the court’s ruling on exhaustion of administrative appeals.
Pursuing a request for expedited judicial review with CMS is also on the table. If a judicial review is expedited, NAHC plans to refine its lawsuit.
“The Court did not rule on the merits of NAHC’s claims that it had violated Medicare laws,” NAHC wrote. “As such, a lawsuit can be pursued once the administrative steps are completed.”
Ultimately, NAHC President William A. Dombi believes that the lawsuit dismissal is a stumbling block, but one that the organization will prevail over.
“We are disappointed with the court’s ruling. However, it is a minor setback that we can readily overcome,” Dombi said in the report. “Often justice delayed is justice denied. Here, we will have our day in court. This battle is far from over.”
In addition to his role as president, Dombi also served as legal counsel to NAHC.
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