Last summer, the National Association for Home Care & Hospice (NAHC) caused a stir 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 the calculation of home health care payments Medicare filed.
Last week, a federal court in Washington DC dismissed NAHC’s lawsuit against CMS and HHS.
The lawsuit alleged that CMS and HHS used an “invalid” method in deciding payment and that recent cuts to home health insurance payments were unlawful.
“The primary allegation in our lawsuit is that the methodology violated the plain language of the Medicare law,” NAHC wrote in its latest report.
CMS has implemented a 3.925% tax cut for 2023 and a 2.89% cut for 2024.
On April 26, the U.S. District Court for the District of Columbia ruled that NAHC skipped a regulatory review process before filing suit.
“The court’s ruling addresses a combination of NAHC’s arguments and the defense arguments presented by the U.S. Department of Justice on behalf of CMS,” NAHC wrote. “The DOJ argued that the court lacked authority to hear any challenges to the PDGM method of adjusting budget neutrality, that the NAHC had not exhausted all administrative appeal steps, and that the challenged method was consistent with the law.”
Nevertheless, NAHC noted that the court ruled in its favor on what it considers to be a crucial aspect of the case.
“[The court rejected] DOJ’s argument that any judicial review is barred with respect to anything related to the PDGM system,” NAHC wrote. “The court specifically held that the NAHC could challenge the budget neutrality adjustment method once administrative remedies have been exhausted. It is also notable that the Court did not rule on or evaluate the merits of NAHC’s claim that the methodology violated Medicare law.”
Last year, the Biden administration asked a federal judge to dismiss NAHC’s lawsuit against CMS and HHS.
Looking forward, NAHC is considering its next move. One of the things the organization is considering is appealing the court’s decision on the exhaustion of administrative appeals.
A request for expedited judicial review from CMS is also under discussion. 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 violated Medicare laws,” NAHC wrote. “Therefore, a lawsuit can be initiated as soon as the administrative steps are completed.”
Ultimately, NAHC President William A. Dombi believes the dismissal of the lawsuit is a stumbling block, but one the organization will overcome.
“We are disappointed with the court’s decision. However, it is a small setback that we can easily overcome,” Dombi said in the report. “Often justice delayed is justice denied. This is where we will spend our day in court. This fight is far from over.”
In addition to his role as president, Dombi also served as legal counsel for NAHC.